Don’t want to get sued? Change your tone.

Very interesting research on the connection between a surgeon’s tone of voice and their likelihood of having been sued for malpractice in an article titled, Surgeon’s Tone of Voice: A Clue to Malpractice history. (Surgery Ambady et al 9 Volume 132, Number 1). Here is a summary of their methods and findings.

Methods: We examined the relationship between surgeons’ voice tone during routine office visits and their history of malpractice claims. Surgeons were audiotaped while speaking to their patients during office visits, and very brief samples of the conversations were rated by coders blind to surgeons’ claims status… Several variables were rated that assessed warmth, hostility, dominance, and anxiety from 10-second voice clips with content and 10-second voice clips with just voice tone.

Results: Controlling for content, ratings of higher dominance and lower concern/anxiety in their voice tones significantly identified surgeons with previous claims compared with those who had no claims


  1. 40 seconds of surgeons’ speech distinguished between claims and no-claims surgeons, revealing the power of the information communicated by the voice.
  2. These findings suggest that, in the medical encounter, “how” a message is conveyed may be as important as “what” is said.
  3. .. for general and orthopedic surgeons, those who were judged to be more dominant were more likely to have been sued than those who sounded less dominant.
  4. These results underscore the potency of vocal communication in medical interaction.
  5. Expressions of dominance may communicate a lack of empathy and understanding for the patient. On the other hand, concern or anxiety in the voice is often positively related to expressing concern and empathy.
  6. Our study findings imply that even very brief exposure to a surgeon’s speech may be perceived by patients as expressing dominance and lacking concern. Dominance coupled with a lack of anxiety in the voice may imply surgeon indifference and lead a patient to launch a malpractice suit when poor outcomes occur.
  7. Our results have potential implications for the selection, training, and continuing education of surgeons,
  8. In summary, this study adds to the burgeoning evidence linking physician-patient communication to important outcomes such as patient dissatisfaction, surgeon shopping, poor adherence to medical directions, and poor health outcomes.
  9. It suggests new information that tone of voice rather than just content of communication may be related to surgical malpractice.

Narrative Medicine

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