A 2017 Medscape survey indicated that over half of responding doctors had been sued for malpractice.  The number one reason?  Failure to diagnose a medical condition, given by 31% of respondents.  Nearly half of doctors surveyed who were sued for malpractice spent between eleven and fifty hours in court, meetings with lawyers, or in other legal proceedings.  And almost half of those surveyed stated that there was no triggering event and that they were taken by surprise by the malpractice claim.

Studies published in the Journal of the American Medicine Association, Lancet, and the Archives of Internal Medicine delved into the mindset of patients who filed malpractice claims using various methods, including questionnaires, deposition transcripts, and phone surveys.  Four primary reasons emerged: 1. prevention of similar incidents in the future; 2. a desire for an explanation about a harmful incident; 3. financial renumeration for pain, loss, and/or suffering or to offset future care expenses; and 4. the need to hold a doctor accountable.

At the root cause of many of these malpractice claims is a breakdown in the relationship between the physician and the patient—typically due to problems with communication.  Patients complained that doctors failed to listen to them, were not clear or open in their discussions, were dismissive of the patient’s or family’s perspective, and showed a lack of understanding for their concerns.  The unifying theme that emerges from these dissatisfied patients is communication—the most crucial aspect of the interaction and relationship between doctor and patient.  The researchers emphasized that if a relationship characterized by both trust and respect was initially established between patient and doctor, that patient was far less likely to sue—despite a doctor’s error in treating that patient.

The first step toward improving communication between doctors and patients is to determine which barriers might stand in the way.  One such barrier is the challenge many doctors face in navigating cultural and societal differences among their patient populations.  Michigan, like the rest of the United States, is rapidly diversifying.  The U.S. Census Bureau reports that approximately 25% of Michigan’s population are persons of color.  Almost 7% of Michigan residents are immigrants, whose top five countries of origin are Mexico, India, Iraq, China and Canada.  And a recent Gallup poll indicates that 10 million Americans, or 4.1% of the population, identify as gay, lesbian, bisexual, or transgender.

So what can physicians do to strengthen their doctor-patient relationships and avoid malpractice claims? A starting point is to develop cultural competence, often defined as a set of knowledge, behaviors, attitudes, and policies that enable effective work in a cross-cultural environment.  Here, culture is defined broadly to include the customs, beliefs, language, and perspectives of racial, ethnic, social, and religious groups.  A culturally competent physician has the ability to work effectively within the particular context of a patient’s cultural practices, beliefs, and needs.

Prioritizing the development of cultural competence can improve communication across cultures.  Research by the Commonwealth Fund and the Office of Minority Health demonstrates that training and education in cultural competence increases the quality of care provided to diverse populations.  These outcomes show that a commitment to cultural competence training is well worth the investment.  Taking initial steps toward developing or enhancing cultural competence does not have be overwhelming or intimidating.  The following are a few ways that practitioners can begin to develop these skills:

1. Recognize and reflect upon one’s own cultural background. Our own assumptions, norms, and beliefs are as familiar as the air we breathe. But failing to recognize and gain awareness of our own background and assumptions makes it more difficult to recognize that patients arrive with their own.  Take time to reflect upon your own background and culture and the ways in which they determine your perspective and norms.
2. Resist stereotyping. Making assumptions based on a patient’s culture or background prevents a physician from seeing that patient as an individual and developing a relationship based on trust and respect. Become aware of the expectations you may have that are based on background and culture.
3. Practice active listening. Cultural differences can make communication more difficult. Practicing active listening is an effective tool to ensure understanding and promote trust.  Active listening is characterized by nonverbal signs that show engagement, as well as speech characterized by questioning, clarifying understanding, and summarizing.
4. Gain knowledge. Who are your patients? Learning about the populations that you serve and their needs, beliefs, and practices is invaluable information. Consider translating forms and having translation services available.

Developing cultural competence is a step toward improving not only communication with patients and delivery of health care services, but also preventing malpractice claims and reducing health care disparities. With benefits like these, training and education in cultural competence is an investment well worth making.

Michelle Khazai  contributed to the article.