Research conducted by the Canadian Medical Protective Association (CMPA) has identified certain factors that can impact a patient's decision about whether to file a medico-legal complaint.

CMPA conducted a thematic analysis of 92 studies through a targeted literature review. This research examined relational dynamics between doctors and patients, highlighting their influence on patient satisfaction and the likelihood of a medico-legal complaint.

The study identified three types of factors that contribute to potential relational challenges between physicians and patients:

• Individual factors, such as the personal characteristics of doctors (i.e. ability to create trust and familiarity, a sense of carefulness) and personal characteristics of patients
• Interpersonal factors, such as effective communication skills, the patient’s perception of the care they received, and physician empathy
• Environmental factors, including health-care system and policy issues

Physicians exhibiting certain characteristics may be less at risk of medico-legal complaints. The ability to listen, have an awareness of patients’ needs, and build a sense of trust are important and fundamental predictors of patient satisfaction, said Dr. Gary Garber, Director, Safe Medical Care Research, CMPA, and co-author of the study.

 “Kindness and empathy are vital for ensuring patient satisfaction,” he said.

The ability to listen, have an awareness of patients’ needs, and build a sense of trust are important and fundamental predictors of patient satisfaction.

These same considerations are reflected in CPSO’s complaints processes, where some of the most frequent matters seen by the Inquiries, Complaints and Reports Committee regarding clinical complaints arise when patients believe a physician has failed to appropriately explain the medical issue or the patient does not feel the physician has adequately listened to their concerns.

The CMPA review also identified several system-level issues that can negatively impact the relationship between patients and physicians, including long wait times for appointments, insufficient time spent with a doctor during an appointment, and difficulty booking appointments.

These issues are often associated with high patient volumes and resource constraints, which may be outside of the control of physicians. Despite the potential impact of systemic issues on patients’ health-care experiences, they have not led to an overall increase in complaints to CPSO, nor would individual physicians generally be held accountable for system deficiencies outside their control. Nevertheless, CPSO continues to support efforts by government, medical organizations (e.g. OMA) and other stakeholders to address physician burnout and administrative burden. 

Strategies to improve workflow and the patient experience, and reduce the likelihood of complaints:

Good communication with patients is a key component of an effective physician-patient relationship and can be demonstrated in different ways:  

• Asking open-ended questions to confirm a patient’s understanding of the discussion and answering questions posed by the patient
• Taking reasonable steps to create and foster a safe, inclusive, and accessible environment in your practice
• Being alert to non-verbal signs that the patient may not be understanding the information
• Making eye contact
• Demonstrating compassion and a collaborative approach to patient decision-making
• Waiting until the patient is finished speaking to respond
• Summarizing what you think the patient has told you and ask the patient whether it is correct

In addition, new strategies and technologies can create more efficient workflows and help reduce the stress of running a busy practice. These can include the adoption of digital platforms, such as integrated electronic medical records, for scheduling appointments and seamless information sharing among health-care professionals. The use of digital scribes can also free physicians from administrative tasks, allowing more time for face-to-face patient interactions and other high value work – a topic covered in a recent issue of Dialogue. Finally, engagement with management or leadership may help secure additional administrative support and resolve broader systems issues.