Back to the future: Can conversation analysis be used to judge physicians’ malpractice history?


  • Richard M. Frankel Indiana University School of Medicine
  • Wendy Levinson University of Toronto



conversation analysis, doctor–patient communication, malpractice, outcome-based research


In its monograph Crossing the Quality Chasm, the Institute of Medicine asserted that 44,000 to 98,000 lives are lost every year due to avoidable medical errors, more than 80% of which involved breakdowns in communication. Medical malpractice claims also involve errors that cause harm, including death. Reasons for malpractice claims have been investigated using variables such as age, race, country of origin, and gender, none of which are predictive. One promising area that has not systematically been studied is the role of face-to-face communication in malpractice claims. To better understand this phenomenon, we tape-recorded 125 doctors (divided equally between surgeons and primary care practitioners), each with 10 consecutive patients. Half of these doctors had been sued at least twice, while the rest had never been sued. We then did a qualitative analysis based on a single taped encounter per doctor using conversation analysis (CA), in order to try to identify which doctors had claims or no-claims histories. While we were able to identify two out of every three no-claims primary care doctors, we were much less successful in identifying those with claims. Surprisingly, in the surgeon group, predictions based on CA were worse than by chance probability. We discuss the implications of our findings for the field of outcome-based communication analysis.

Author Biographies

Richard M. Frankel, Indiana University School of Medicine

Dr Richard Frankel, PhD, is Professor of Medicine and Geriatrics at Indiana University School of Medicine and Director of the Walther Program in Palliative Care at the IU/Simon Cancer Center. He is also the Associate Director of the VA Center for Healthcare Information and Communication (CHIC) Center. He has published more than 225 research papers in the area of physician–patient communication and organizational culture change.

Wendy Levinson, University of Toronto

Dr Wendy Levinson, MD, is Professor and past Chair of the University of Toronto’s Department of Medicine. She has served as Chair of the American Board of Internal Medicine (ABIM), and was President of the Association of Professors of Medicine and the Society of General Internal Medicine and served on the ABIM Foundation Board of Trustees. Dr Levinson is a national and international expert in the field of physician–patient communication.



How to Cite

Frankel, R. M., & Levinson, W. (2015). Back to the future: Can conversation analysis be used to judge physicians’ malpractice history?. Communication and Medicine, 11(1), 27–40.