The claimants emphasized how they regarded medicine as a business rather than as a humanistic undertaking. They did not feel that their physicians were receptive to them as people and they felt marginalized-- that the personal and social concerns related to their medical problems were pushed to the periphery. Yet many claimants continued to be deferential toward their physicians in spite of the fact that they had a distrust of their physicians or that they had sued them.
The physicians described medicine as fraught with frustration. Their time demands and workload pressures made it difficult to spend adequate social time with patients. The threat of malpractice affected the physicians profoundly since they saw patients as potential threats. The resulting distrust encouraged the physicians to practice defensive medicine, which was seen as insurance against future claims.
It is clear that both physicians and claimants felt that factors hindering the establishment of meaningful communication were at work. The reasons for this feeling varied between physicians and claimants because of their differing experiences of medicine. Certainly physicians needed adequate time and the willingness to listen to patients talk about how their social lives were related to their medical conditions--what Elliott Mishler refers to as their voice of the lifeworld--in order to improve relations with their patients. 17
By understanding the anxieties and social contexts of their patients, physicians could gain important information that could improve diagnosis and treatment. Good communication and relationships do more than make each party feel good. Evidence shows that the quality of the physician-patient relationship affects the outcome of disease among patients with ulcers, breast cancer, diabetes, and hypertension. 18 For example, some researchers have found that patient-physician relationships characterized by more patient control, more physician affect, and more information provided by the physician are associated with a better health status of the patients at follow-ups. In their review of the literature, L.N.L. Ong and his colleagues reported several findings that more information from physicians improved patient satisfaction, as did expressions of affective behavior such as listening, eye contact, and discussion. 19 In addition, patients are less likely to sue physicians with whom they have good rapport, all other things being equal. The importance of a good bedside manner is documented also in a study by Gerald Hickson and his colleagues. 20 They found that the physicians in Florida who had the most malpractice claims were also the most likely to have patients who complained about feeling rushed, not receiving explanations regarding test results, and being ignored. Overall, the patients in their