Doctors stew over personality tests as insurer ties results to rates

Researchers who have studied physician personality traits want to see their work used to help physicians, not penalize them.

By Tanya Albert, amednews staff. Oct. 27, 2003.

In what experts say could be a harbinger of things to come, at least one liability insurer is now asking doctors to complete a three-page communication skills assessment as a condition of policy renewal.

"Tranquil," "meticulous," "sympathetic," "opinionated," "devoted," "agreeable," "tense" and "perfectionist" are among the 81 word choices physicians contemplate when asked to describe how other people would describe them. Next, physicians are asked to check the words that they would use to describe themselves.

Are you ... impulsive, cautious?
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Topic: Liability crisis

Doctors also are being asked to respond to what they believe is appropriate job behavior to be successful. For example, is it "unimportant, important or critical" to "being competitive, winning"? They are asked to check off their "ideal supervisor or workplace" by answering whether they "need, like or dislike" a "workplace governed by rules, tradition, protocol" or whether "the boss is a hands-off manager, a resource."

Some studies have shown that communication skills can play a part in predicting the odds of a physician getting sued for medical malpractice. Now Michigan-based American Physicians Assurance Corp. is believed to be the first that is trying to gather that information as part of its underwriting process.

But experts say they wouldn't be surprised to see more insurers turn to alternatives like this in the current tough medical liability market. Physicians already have seen rates increase, underwriting criteria tighten and numerous medical liability carriers flee the market.

"I have not heard of other companies yet doing that," said general surgeon Michael S. Woods, MD, whose Illinois-based Woods Development Institute has studied the communication issue and developed programs to help physicians improve their skills. "Having said that, it's going to happen. It's an extraordinarily hard market, and companies are trying to get a handle on risk assessment."

That doesn't mean researchers or physicians are happy about it.

Physicians concerned

American Physicians Assurance previously had used the communication assessment for new policies but is now trying the tactic with policyholders up for renewal in Ohio and Illinois.

In a letter to policyholders up for renewal, the company told doctors the assessment test was mandatory and that underwriters might contact them for an on-site risk management visit. "These items may qualify you for a premium discount," the letter states.

But some doctors worry that assessment results could result in higher rates or nonrenewal of their policies as well. And they question whether the open-ended questions on the test are too broad, producing results that are easily second-guessed.

"I question the validity of the assessment," said a family physician in one of the two states in which American Physicians Assurance is using the assessment. "Is this a truly well-studied assessment?"

Cathy Burke, marketing and communications director for the underwriter, said she sees no reason physicians should be concerned.

The company, which is actively writing policies in six states and insures about 13,000 physicians in 13 states, decided to add the assessment after its own research and others' research showed that communication and patient rapport play a part in the likelihood of being sued, she said.

"It is important for physicians to keep patient communication in the forefront of their minds," she said. "It is feasible that if the results [from the assessment] came back negatively and there is a large loss claims history that a physician could be nonrenewed. But they would not be nonrenewed only on the assessment factor."

There are many things that contribute to lawsuits being filed against physicians, but there have been several studies in recent years that connect communication and personality with lawsuits.

"Patient Complaints and Malpractice Risk," published in the Journal of the American Medical Association on June 12, 2002, showed that of 645 physicians studied, those named in a lawsuit generated more complaints from patients who were dissatisfied than those not named in a lawsuit.

Similarly, Dr. Woods' studies of surgeons showed that those who were sued scored lower in areas of executive leadership, attention to detail and conformity to standards than surgeons who were not sued. Those sued also tended to be independent, have strong egos and deny having problems with anger or impatience.

Using the data

But researchers question how companies would go about fairly evaluating physicians in the underwriting process. Also, they want to see their research used to help their colleagues improve personality traits or communication skills that tend to lead to lawsuits. They don't want to see their research used for punitive reasons.

"Our intention has never been to promote a notion that we have a magic instrument that can measure skills," said Gerald B. Hickson, MD, an author of the JAMA study and director of the Vanderbilt Center for Patient and Professional Advocacy in Nashville, Tenn.

Instead, Dr. Hickson sees the research as evidence that physicians can help themselves cut the risk of being sued. By asking patients how satisfied they are with a physician experience, doctors can discover areas where they might be able to improve.

For example, they may discover that they need to take more time to help patients understand diagnoses or show more respect for patients by reducing the amount of time they wait to see a doctor. By being aware, a doctor can change those behaviors and, in turn, create a more positive experience for the patient, improve health care and reduce chances of a lawsuit.

Dr. Woods agrees.

"We don't advise companies to determine underwriting based on assessments," he said. "Woods Development Institute firmly believes personal assessment is a powerful tool that should be used as risk management and for providing tools for improvement, not for underwriting."