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Int J Gen Med. 2011 Apr 12;4:289-97. doi: 10.2147/IJGM.S18727.

Association between physician explanatory behaviors and substandard care in adjudicated cases in Japan.

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Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Higashi-ku, Fukuoka, Japan;



When a physician provides an insufficient explanation to a patient, such as regarding diagnosis, treatment, drug use, or prognosis, the physician is deemed to have delivered substandard care. It is likely that the standards applied to physicians' explanations have changed as a result of the increased importance of patients' rights of self-determination. However, little or no research on decisions in medical malpractice cases has been conducted with respect to this issue.


Based on decisions made in 366 medical malpractice cases between 1979 and 2008 focused primarily on the physician's duty to explain relevant issues to patients, we examined the association between physicians' explanatory behaviors and court decisions with respect to breaches of duty.


We found that physicians' explanatory behaviors, including relevant and specific explanations provided before treatment or surgery, were important for fulfilling a physician's duty to explain. The data also revealed that six of the 16 types of explanatory behaviors had improved during the past three decades. However, these improvements did not contribute to the fulfillment of the physician's duty to explain.


We found that there was an association between physicians' explanatory behaviors and judicial decisions concerning substandard care, and courts were increasingly likely to consider inadequate explanatory behaviors to be a breach of the duty of care.


explanation; patient rights; physician; self-determination

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