While most physicians understand that a serious deficiency in technical care increases their risk of liability, too often their risk management behavior indicates that they do not fully appreciate the impact that poor interpersonal skills have on patients' motivations to sue. Ironically, many of these physicians have taken risk management steps that have increased, rather than reduced, their exposure to lawsuits. In this paper, we argue that a strong legal and factual claim does not invariably explain patients' decisions to sue. Dissatisfaction with the physician's interpersonal care as well as with the clinical outcome is often a factor. Conversely, patients with a potentially meritorious claim may forego legal action due to the strength of the relationship with the physician. In view of patients' motivations to sue, we advocate a more broadly conceived approach to reducing liability risk, one that honors the ethical aspirations of medicine instead of the secretive counsels of misguided risk management. To be sure, strategies to reduce technical error are necessary, but they are not sufficient. Errors causing harm will inevitably occur. The first step in the liability path is the patient's decision to transform the fact of harm into a legal claim. Whether this crucial first step is taken, as research has shown, can be strongly influenced by the physician's interpersonal competence: the more open and honest physicians are towards their patients, the less likely these patients will pursue litigation. Thus, we argue that physicians should seek to establish strong relationships with their patients and avoid questionable "defensive medicine" practices that can harm these relationships.
Anand Das, Jack Schwartz, & Evan G. DeRenzo, True Risk Management: Physicians' Liability Risk and the Practice of Patient-Centered Medicine, 18 J.L. & Health 57 (2003-2004)