Doctors’ Scores on Communication Predict Complaints to Authorities

by Teri Robert, Lead Expert

“We found that communication and clinical decision-making ability were important predictors of future complaints to regulatory authorities.” 1


Patients who feel that their relationship with their doctors is lacking two-way communication will be especially interested in a JAMA article released today. Tamblyn et al concluded, “Scores achieved in patient-physician communication and clinical decision making on a national licensing examination predicted complaints to medical regulatory authorities.” 1

Poor skills in patient communication is not a new issue. For decades, research has shown poor communication skills to be associated with:

  1. lower levels of patient satisfaction,
  2. more complaints,
  3. a higher risk of malpractice claims, and
  4. poorer health outcomes.

Although medical schools responded to these issues by adding patient communication and clinical skills to their curriculum, there was neither any systematic evaluation of these skills nor a minimum proficiency required for physicians to be licensed. From 1993 to 2004, The Medical Council of Canada, the Educational Commission for Foreign Medical Graduates, and the United States Medical Licensing Examination have all introduced a clinical skills examination (CSE) as a requirement for licensing. The CSE is a standardized assessment of physician skills in patient-physician communication, taking clinical history, and examination.

In this study, the authors investigated:

  • the ability of CSEs to predict future complaints in medical practice
  • the hypothesis that lower scores in patient/physician communication would be associated with a higher rate of patients’ complaints about quality of care and communication, and
  • whether the use of clinical examination scores improved the prediction of complaints beyond results from the traditional written examination.


Study methods

  • 3,424 physicians who took the Medical Council of Canada clinical skills examination between 1993 and 1996 were licensed to practice in Ontario and/or Quebec were followed until 2005.
  • Data was collected on complaints filed about these physicians with regulatory agencies.
  • The authors “conducted a sensitivity analysis including all complaints to assess whether our findings were influenced by retention decisions. The subset of retained complaints that were related to problems in communication and quality of care were assessed as secondary outcomes, as these problems should be more strongly associated with the competencies being assessed by the examination.”
  • The rate of complaints was calculated for each physician.

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