Happy patient
Risk Management

Do Happy Patients Mean Lower Malpractice Risk?

Is patient satisfaction a significant determinant of whether or not a patient will file a malpractice action against you? Defense attorney Thomas Jensen says that patient satisfaction is among the myriad of items able to be captured by various studies, surveys, EHR databases and patient survey instruments. And this evidence shows that high patient satisfaction substantially reduces the risk of a malpractice suit.


A malpractice suit is an expensive, disruptive and emotionally stressful event in any clinician’s career. However, in today’s litigious society, such suits are a commonplace event.

Current research estimates that by age 65, 75 percent of physicians in low-risk specialties and 99 percent in high-risk specialties have been subject to at least one claim.[i]

Data on the frequency of chiropractic malpractice suits is minimal compared to allopathic malpractice litigation.[ii] However, statistics from the National Practitioner Data Bank (NPDB) from September 1990 through January 2012 show a total of 5,796 malpractice reports filed[iii] for approximately 44,000 chiropractors operating over the period (US Bureau of Labor Statistics, 2012).

Although these numbers imply a lower base rate of malpractice risk for chiropractors, the damaging effects of a lawsuit—loss of license, bankruptcy and substantial practice disruption—remain.[iv]

Current evidence suggests that high patient satisfaction substantially reduces the risk of a malpractice suit.[v] Studies suggest that the degree of satisfaction with a doctor can predict such risk. For example, a study conducted on a large Midwestern healthcare provider showed that doctors with a low score of “very good” had a 0 percent risk of a lawsuit, while doctors with a “very poor” rating as their lowest score had a 19 percent risk.[vi]

Most clinicians in private practice do not compile valid patient satisfaction data. In contrast, clinicians who practice in hospitals or specialty centers have their satisfaction scores surveyed by the institutions for reasons ranging from improving quality of care to determining reimbursement.

When assessing patient satisfaction, the use of accurate, sound tools is critical. The current standard for the healthcare industry is the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which is demonstrated to provide reliable standardized measurement of patient satisfaction across hospital and ambulatory care settings.[vii]

Doctors of Chiropractic are participating in many integrated settings, the VA, DOD, for profit and not-for-profit hospitals and other commercial health networks. With growing evidence supporting the cost effectiveness and value of chiropractic services, determining patient satisfaction levels will become even more critical to DCs.

Some EHRs provide ways to identify rates of patient satisfaction. Many organizations are trying to determine ways to incorporate patient satisfaction scores from the data doctors currently report. Furthermore, third-party entities are gathering and providing data to clinicians for internal use and/or for entities to collect.      

It will be critical that this data is accurate and complete. Armed with patient satisfaction data, doctors can analyze this information to mitigate litigation risk due to unsatisfied patients. Obtaining this information anonymously from patients allows doctors the chance to accurately assess: “How are we doing?”

Moreover, many third-party insurance networks will begin to use patient satisfaction data to determine the value of potential network participants. Therefore, a doctor’s ability to participate in a network could be affected by their patient satisfaction scores.

[i] Grammich, C. (2011). Malpractice Risk by Physician Specialty. RAND Institute for Civil Justice and RAND Health Series, Report No RB-9610. Website: https://www.rand.org/pubs/research_briefs/RB9610/index1.html

[ii] Stevinson, C. & Ernst, E. (2002). Risks Associated with Spinal Manipulation.  American Journal of Medicine; 112 (7): 556-71. Website: https://www.ncbi.nlm.nih.gov/pubmed/12015249

[iii] Medical Malpractice Statistics (2012). Retrieved March 16, 2019. Website:  https://www.medicalmalpracticelawyers.com/blog/chiropractor-malpractice-statistics/

[iv] Salber, Patricia (2015). What Happens When Doctors Get Sued. The Doctor Weighs In. Retrieved March 16, 2019. Website: https://thedoctorweighsin.com/what-happens-when-doctors-get-sued/

[v] Fullam, Garman, Johnson, & Hedberg (2009). The use of patient satisfaction surveys and alternative coding procedures to predict malpractice risk. Medical Care, May; 47(5): 553-9.

[vi] Fullman, (2010). The Link Between Patient Satisfaction and Malpractice Risk. Press Ganey White Paper Series. Retrieved March 16, 2019. Website: https://helpandtraining.pressganey.com/Documents_secure/White%20Papers/wp_malpractice_patientsat_link021910.pdf

[vii] Becker’s (2015). Patient satisfaction and physician communication: Drivers of medical malpractice costs. Becker’s Hospital Review. Retrieved March 16, 2019. https://www.beckershospitalreview.com/finance/patient-satisfaction-and-physician-communication-drivers-of-medical-malpractice-costs.html


The information in the NCMIC Learning Center is offered solely for general information and educational purposes. It is not offered as, nor does it represent, legal or professional advice. Neither does this information constitute a guideline, practice parameter or standard of care. You should not act or rely upon this information without seeking the advice of an attorney familiar with the specific legal requirements of the state(s) in which you practice. If there is a discrepancy between the site and an insurance policy you have with NCMIC, the policy will prevail.