“They wouldn’t listen….”Why do patients sue doctors?  Angela Melville – angela.l.melville@iisj.esScientific Director’s Tal...
International Institute             for Sociology of Law• Each director stays for two years only• Angela Melville (Flinder...
Clinical negligence• A clinical negligence claim involves an  injured patient suing their doctor• The patient believes the...
Our researchUniversity of Manchester, School of Law(with Frank Stephen, Anne-Maree Farrell, Sarah Devaney)1) Funded by Nuf...
Previous research• Usually researchers talk to medical  professionals  – Doctors believe patients sue because they    want...
Questionnaires• Can provide reliable, generalisable results  which are relatively easy to analyse• However:  – Responses a...
In-depth interviews• Allowed claimants to raise topics important  to them• Looked at the entire experience of  claiming• A...
Ethical issues• Wrote to claimants asking consent to interview  – Some claimants were not contacted  – Consent was volunta...
Sensitive interviewing• Recovery can be long and slow, and each  interviewee may be at a different stage in  this process•...
Impact on researchers• Interviewing can be emotional work• Can leave researcher feeling emotionally  overloaded, isolated,...
Dealing with emotional interviews• Set clear boundaries about what the  research can do• Practice the interview beforehand...
…then he just sat up and he looked like, you know The Scream,Edvard Munch’s picture? And just this massive, massive spurt ...
What went wrong?• Patient had been injured• But also:  – Medical treatment had been delayed  – Lack of dignity  – Medical ...
Making a complaint• Hospital would not accept responsibility• Denied that there had been a problem• Doctors had been arrog...
Unsuccessful claims• 1st need to gather all the medical reports• 2nd independent expert looks at the  reports• Claimants f...
Successful claims• Only outcome was often money• But claimants also wanted:  – Explanations  – Apology  – Changes so that ...
Fault based schemes• Claimant must prove that the doctor was  at fault• Benefits  – Deterrance (doctors are more careful) ...
Problems• Defensive medicine• Doctors do not admit errors• Patients with low value claims cannot find  legal representatio...
No fault schemes• Eg New Zealand• Claimant does not have to prove liability• Benefits  – More low value claims receive com...
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"They wouldn't listen...". Why do patients sue doctors?

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Talk given by Angela Melville, Scientific Director at the IISL, the 15th December 2011. The talk deals with research made on clinical negligence claims and the ethical issues involved in this kind of sensitive research.

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"They wouldn't listen...". Why do patients sue doctors?

  1. 1. “They wouldn’t listen….”Why do patients sue doctors? Angela Melville – angela.l.melville@iisj.esScientific Director’s TalkDate: 15th December 2011
  2. 2. International Institute for Sociology of Law• Each director stays for two years only• Angela Melville (Flinders University, Australia) is the new director – In 2010 we had 32 visiting scholars – In 2011 we had 198 workshop participants – In 2011 we had 220 conference participants – We currently have 13 Masters students from 11 different countries
  3. 3. Clinical negligence• A clinical negligence claim involves an injured patient suing their doctor• The patient believes the doctor was negligent• Patients may have suffered serious injuries or have lost a family member
  4. 4. Our researchUniversity of Manchester, School of Law(with Frank Stephen, Anne-Maree Farrell, Sarah Devaney)1) Funded by Nuffield Foundation – Based in northern England – Talked to 30 claimants2) Funded by Scottish Government – Based across Scotland – Talked to 40 claimants
  5. 5. Previous research• Usually researchers talk to medical professionals – Doctors believe patients sue because they want money – Law reform reflects only one set of views• 6 previous studies involving claimants – 5 in the US; 1 in the UK – All used questionnaires
  6. 6. Questionnaires• Can provide reliable, generalisable results which are relatively easy to analyse• However: – Responses are pre-determined – Limited aims (motivations) – Insensitive
  7. 7. In-depth interviews• Allowed claimants to raise topics important to them• Looked at the entire experience of claiming• Allowed claimants to feel listened to
  8. 8. Ethical issues• Wrote to claimants asking consent to interview – Some claimants were not contacted – Consent was voluntary – What topics are to be discussed, length of interview, order of topics – Did not re-contact• Many claimants rang up first• Counsellor on stand-by• List of contacts
  9. 9. Sensitive interviewing• Recovery can be long and slow, and each interviewee may be at a different stage in this process• Researcher cannot know fully what someone has gone through• Gap between academic knowledge and personal knowledge• Researcher needs to be comfortable
  10. 10. Impact on researchers• Interviewing can be emotional work• Can leave researcher feeling emotionally overloaded, isolated, desensitived, uncomfortable with level of disclosure• Feel as if you need to give something back• Impact can be on: interviewers but also transcribers, other research assistants
  11. 11. Dealing with emotional interviews• Set clear boundaries about what the research can do• Practice the interview beforehand• Do background reading• Regularly debrief• Have a mentor• Work in a team• Keep a diary
  12. 12. …then he just sat up and he looked like, you know The Scream,Edvard Munch’s picture? And just this massive, massive spurt ofblood came out, and he was just like this… and then he died.And they still wouldn’t let me in the ambulance, they left me on theroad, then they let me in the ambulance, and he’d died. And I said Ithink you ought to close his eyes, he’s passed away. And theystarted giving him CPR, and there wasn’t anything of him, it wouldhave broken all his ribs, they were just being so rough... Theywouldn’t close his eyes, they wouldn’t, they wouldn’t stop doing thaton his chest, and they did that all the way to the hospital. And Ibegged them not to, just to leave him in peace and then theywouldn’t even cover his face when he went through A and E and allthese people were just looking at him, and he’d died. And I thought itwas just so cruel, I just thought that was so cruel and undignified.
  13. 13. What went wrong?• Patient had been injured• But also: – Medical treatment had been delayed – Lack of dignity – Medical staff had been rude – Poor communication – Knew there was a problem, but no-one would listen
  14. 14. Making a complaint• Hospital would not accept responsibility• Denied that there had been a problem• Doctors had been arrogant• Hospital tried to blame a junior doctor or nurse• Did not feel listened to
  15. 15. Unsuccessful claims• 1st need to gather all the medical reports• 2nd independent expert looks at the reports• Claimants felt that the expert was: – Biased – Had missed the most important points – Refused to listen• Majority of claims fail
  16. 16. Successful claims• Only outcome was often money• But claimants also wanted: – Explanations – Apology – Changes so that mistakes would not happen to someone else – Opportunity to talk to the doctor – Receive compensation, but still felt as if no- one would listen
  17. 17. Fault based schemes• Claimant must prove that the doctor was at fault• Benefits – Deterrance (doctors are more careful) – Doctors learn from their mistakes – Only claims with merit receive compensation – Claimants get the full value of their claim
  18. 18. Problems• Defensive medicine• Doctors do not admit errors• Patients with low value claims cannot find legal representation• High proportion of settlement is paid to the lawyer rather than the claimant• Only provide financial compensation
  19. 19. No fault schemes• Eg New Zealand• Claimant does not have to prove liability• Benefits – More low value claims receive compensation – Can provide alternative outcomes – Less need for legal representation, therefore lower costs – Doctors more likely to admit errors – Also need to have compulsory disclosure of errors

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