Demeanor and Personality: Chips in the Liability Roulette

by Mark Gorney, M.D., F.A.C.S., Medical Director, Board of Governors

When I was in medical school many years ago, there was the popular—if cynical—theory among the students that held that the top third of the class would make the best researchers and professors, the middle third the best clinicians, and the bottom third the most money. In other words, the bottom third would probably have the busiest practices.

Gifted Practitioner, Poor Physician

I have thought about this over the years, and considering my own class experience, I find the theory reasonably accurate. From a slightly different perspective, the corollary holds that you don’t necessarily have to be a brilliant scholar to be a highly successful physician. As I look around my circle of medical friends, I am struck by a much more accurate measure of success that is the odd combination of charm, sensitivity, awareness, wit, verbal skills, and warmth known as personality, which the public often refers to as a bedside manner.

Regrettably, these characteristics cannot be learned in a classroom. Instead, they are a combination of the individual’s genetic program and what he or she has learned at mother’s knee. All of us have known colleagues who are at the top of their specialty. These doctors are often extraordinarily gifted practitioners but seen as poor physicians because they are perceived as cold or aloof, if not arrogant, and their exceptional intelligence makes them appear impatient and contemptuous or patronizing.

Personality Traits on Trial

Nowhere is this phenomenon more obvious than in the area of medical liability exposure. Although there are no studies relating frequency of claims to personality factors (it would be virtually impossible to structure a valid study), I am nonetheless always struck by the importance that claims professionals place on this aspect of their policyholders’ defensibility.

Personality plays a significant role in the attorney’s game plan, either in the assault on the occupant of the witness stand, or in the preparation of the client’s defense. Exit polls reveal that juries are as heavily influenced during deliberations by their feelings about a defendant or a witness as they are by the facts of the case. This was recently confirmed by Medical Economics in an interview with physician and plaintiffs’ attorney Bruce Fagel, M.D., J.D., who states, “The doctor’s personality can be just as important as the medical details and expert testimony.”

The stress that medical malpractice litigation induces in the average defendant doctor does not permit an accurate evaluation of true personality traits or the ability to communicate. Nevertheless, until the unlikely time that we can go to an effective alternative dispute resolution scheme, physicians must learn to cope.

Many malpractice actions are based not so much on what went wrong, but on what was said or not said, how it was said, or how often. Always remember that a malpractice action has much less to do with truth, justice, or fairness than it does with theatrics. The best actors walk off with the applause and the prize. Unfortunately, busy clinicians by and large consider personality inventories or advice on interpersonal communication to be demeaning or a waste of time. Malpractice carriers, who do understand the benefit of such exercises, don’t agree. Our experience shows that every physician can benefit from taking the time to improve his or her communication skills. We have devoted a segment of our Risk Management Strategies articles to this important topic.

Prophylactic Treatment

There are entire shelves of written materials on the science of communications and interpersonal chemistry. Some of it is obvious, but much of it is useful. If you visit the General Risk References section on the Publications page of our Web site at www.thedoctors.com, you will find three interesting and useful essays on communication:

• Effective Physician Communication Skills
• Telephone Communication for Physicians
• From Surprise and Disappointment to Anger and a Lawsuit

I recommend that all physicians review these articles as prophylactic treatment. Every physician can appreciate the significance of these articles when a defense attorney is giving instructions on behavior and communication techniques in preparation for a deposition or the courtroom. By then, however, it is almost always too late.