Elsevier

Surgery

Volume 132, Issue 1, July 2002, Pages 5-9
Surgery

Surgical Outcomes Research
Surgeons' tone of voice: A clue to malpractice history*,☆☆

https://doi.org/10.1067/msy.2002.124733Get rights and content

Abstract

Background. Interpersonal aspects of care, such as the communication behaviors of physicians, are often cited as central to patients' decisions to initiate malpractice litigation. Relatively little is known, however, about the impact of the communication behaviors of surgeons. In the current study, we investigated the relationship between judgments of surgeons' voice tone and their malpractice claims history. Methods. We examined the relationship between surgeons' voice tone during routine office visits and their history of malpractice claims. Surgeons were audiotaped while speaking to their patients during office visits, and very brief samples of the conversations were rated by coders blind to surgeons' claims status. Two 10-second clips were extracted for each surgeon from the first and last minute of their interactions with 2 different patients. Several variables were rated that assessed warmth, hostility, dominance, and anxiety from 10-second voice clips with content and 10-second voice clips with just voice tone. Results. Controlling for content, ratings of higher dominance and lower concern/anxiety in their voice tones significantly identified surgeons with previous claims compared with those who had no claims (odds ratio [OR] 2.74, 95% confidence interval [CI] 1.16 to 6.43 for dominance; OR 0.46, 95% CI 0.21 to 1.01 for concern/anxiety). Conclusions. Surgeons' tone of voice in routine visits is associated with malpractice claims history. This is the first study to show clear associations between communication and malpractice in surgeons. Specific types of affect associated with claims can be judged from brief audio clips, suggesting that this method might be useful in training surgeons. (Surgery 2002;132:5-9.)

Section snippets

Overview

The study used 114 conversations recorded during routine medical visits between patients and community-practicing surgeons. Half of the surgeons had previous malpractice claims and half had never experienced a claim. Brief 10-second segments of the tapes were extracted and coded for tone of voice. Logistic regressions were performed to examine the contribution of voice tone, beyond the content of speech, to predicting malpractice claims history.

Physicians

Sixty-five surgeons (orthopedic and general

Surgeon demographics

Of the 57 surgeons, 23 were general surgeons and 34 were orthopedic surgeons. The median number of years since medical school graduation was 15.5, ranging from 12 to 41 years. The mean self-reported number of hours with patients per week was 58, with a range of 18 to 76 hours. More than half the surgeons were in single-specialty groups, a few were in multispecialty groups, and the rest were in solo practice. Except for 2 African-American men and 1 Native-American man, all the surgeons were

Discussion

Ratings of surgeons' tone of voice from very brief segments (four 10-second clips) of audiotaped conversations were associated with the previous malpractice claims of surgeons, after controlling for vocal content. Thus, 40 seconds of surgeons' speech distinguished between claims and no-claims surgeons, revealing the power of the information communicated by the voice. These findings suggest that, in the medical encounter, “how” a message is conveyed may be as important as “what” is said.

References (28)

  • GM Glasgow

    A semantic index of vocal pitch

    Speech Monogr

    (1952)
  • C Wolbert

    The effects of various modes of public reading

    J Appl Psych

    (1920)
  • A Mehrabian et al.

    Nonverbal concomitants of perceived and intended persuasiveness

    J Pers Soc Psych

    (1969)
  • JK Burgoon et al.

    Nonverbal behaviors, persuasion, and credibility

    Hum Commun Res

    (1990)
  • Cited by (312)

    • Coping With Radiology Malpractice Litigation

      2022, Journal of the American College of Radiology
    View all citing articles on Scopus
    *

    Supported by the Agency for Health Care Policy Research, Grant No. RO1 HS07289, the Bayer Institute for Health Communication, and the National Science Foundation Presidential Early Career Award for Scientists and Engineers (SBR 9733706).

    ☆☆

    Reprint requests: Nalini Ambady, Department of Psychology, 1420 William James Hall, Harvard University, Cambridge, MA 02138.

    View full text