Impact of miscommunication in medical dispute cases in Japan.

OBJECTIVE Medical disputes between physicians and patients can occur in non-negligent circumstances and may even result in compensation. We reviewed medical dispute cases to investigate the impact of miscommunication, especially in non-negligent situations. DESIGN Systematic review of medical dispute records was done to identify the presence of the adverse events, the type of medical error, preventability, the perception of miscommunication by patients and the amount of compensation. SETTING The study was performed in Kyoto, Japan. PARTICIPANTS We analyzed 155 medical dispute cases. MAIN OUTCOME MEASURES We compared (i) frequency of miscommunication cases between negligent and non-negligent cases, and (ii) proportions of positive compensation between non-miscommunication and miscommunication cases stratified according to the existence of negligence. Multivariate logistic analysis was conducted to assess the independent factors related to positive compensation. RESULTS Approximately 40% of the medical disputes (59/155) did not involve medical error (i.e. non-negligent). In the non-negligent cases, 64.4% (38/59) involved miscommunication, whereas in dispute cases with errors, 21.9% (21/96) involved miscommunications. (P <thinsp;0.01) Although almost at negligent dispute cases were compensated (94/96), the frequency of positive compensation in non-negligent cases was significantly higher if miscommunication was perceived: 78.9% (30/38) with miscommunication and 52.4% (11/21) with non-miscommunication (P < 0.05). The presence of medical error and patients' perception of miscommunication were important predictors of positive compensation (odds ratio: 36.9 and 3.6, respectively.) CONCLUSIONS Medical disputes can occur without negligence and may have costly consequences. Medical staffs need to understand that not only the 'presence of medical errors', but also 'patients' perception of miscommunication', especially in cases with a non-negligent adverse event, can cause serious medical disputes. To prevent future disputes or claims, there is a strong need to improve communication between providers and patients or their relatives.