Lawyer Porosnicu Gianina Vera

18/04/2025

Physician–Patient Communication: A Premise for Medical Malpractice Claims

Poroșnicu Gianina Vera

Iași Bar Association

INTRODUCTION
​ Physicians represent an essential component of our society. They make continuous efforts to help individuals facing health problems lead a normal life. This profession is far from easy—it requires a significant number of personal qualities. Among these is charisma, which refers to the ability to convey messages to patients effectively.
The specialized literature emphasizes that, in the field of healthcare, the manner in which medical information and messages are communicated directly influences treatment outcomes (1). Moreover, when patients seek medical services, they are often in a vulnerable health condition. Using appropriate and empathetic language can help foster trust in the medical professional.Additionally, a 2024 study found that effective physician–patient interaction tends to increase patient satisfaction (2).
According to other research, physician–patient communication encompasses not only asking questions but also providing relevant and meaningful information (3). Patients need empathy and a sense of security. Physicians have a duty to be mindful of these aspects—even in situations where patients may demonstrate a limited understanding of the information being conveyed.

PHYSICIAN–PATIENT COMMUNICATION FROM A LEGAL PERSPECTIVE
Regarding the way in which physicians communicate, there are several legal aspects worth mentioning. In principle, the physician–patient relationship becomes a matter of legal interest when the patient decides to file a complaint against the medical professional (4). Moreover, the right to file a complaint against a physician is legally recognized, and any limitation of this right is not permissible in a society that promotes democratic values.
According to Article 27 of the Medical Code of Ethics, titled Clarity Diligence, the physician who has responded to a medical request must ensure that the patient fully understands the prescription, recommendation, or any other medical instruction, as well as whether the patient is being referred to another medical institution or placed under the care of a different specialist.
Communication is also regulated by the provisions of Law No. 46/2003 on Patients’ Rights, published in the Official Gazette No. 51 on January 29, 2003. According to Article 8, information must be communicated to the patient in a respectful and clear manner, minimizing the use of specialized terminology. If the patient does not understand the Romanian language, the information must be provided in their native language or in a language they understand; alternatively, another appropriate form of communication must be found. If the patient is not a Romanian citizen, the information must be delivered in an international language or, where applicable, by using another form of communication.
The Code of Ethics for Dental Practitioners is also relevant, as it prohibits the communication of information that may create unfounded expectations or fears, or that may, in any way, jeopardize the general interest of society.
These regulations demonstrate the Romanian legislator’s strong interest in how physicians communicate with patients. The abundance of legal and ethical documents addressing this issue underscores the crucial role that the physician–patient relationship plays in the provision of medical care.

THE RELATIONSHIP BETWEEN COMMUNICATION AND MEDICAL MALPRACTICE COMPLAINTS
The concept of medical malpractice has been defined in various ways in the specialized literature, each interpretation attempting to capture the essence of this complex field. Some authors describe medical malpractice as “errors or negligence committed by doctors and medical personnel during the treatment of patients” (5). Other studies emphasize that medical malpractice refers to “harm caused by a physician or healthcare provider due to the failure to apply standard practices during diagnosis and treatment, either because of a lack of competence or by omitting to provide necessary treatment.”
Regardless of how we choose to define the notion of medical malpractice, the core idea remains the same: malpractice involves an act or omission by a healthcare professional that results in harm to a patient. From this perspective, both in Romania and in other countries around the world, jurisprudence is extensive when it comes to cases in which patients have suffered as a result of medical interventions.
There is, therefore, a close connection between malpractice complaints and physician communication. A physician is a professional who, by the very nature of the profession, interacts regularly with patients. Communication is not limited to verbal interaction—written documentation required during medical procedures is also a form of communication.
One such example is the informed consent form. This document, which has sparked considerable debate in both legal and medical circles, represents a form of non-verbal communication whereby the patient is informed about various aspects such as the procedure itself, potential risks, and other relevant considerations.
A 2022 study conducted in the United States found that orthodontists believe effective communication with patients plays a key role in reducing the risk of receiving complaints (6). It is evident that healthcare providers recognize the importance of using effective communication.
Further proof of the connection between physician communication and malpractice complaints is provided by a 2023 study from South Korea, which identified risk factors associated with malpractice claims. These included issues in the physician–patient relationship and poor communication skills among some healthcare professionals (7).
Communication should not be arbitrary—it is recommended that it meet certain standards. In this regard, some studies affirm that healthcare personnel should maintain a polite and respectful attitude, as this can increase patient satisfaction, improve attentiveness to the proposed treatment plan, and enhance overall well-being (8).
Moreover, other studies on physician–patient communication stress the importance of a two-way dialogue between healthcare providers and patients. Effective communication implies that both parties have the opportunity to speak and be heard (9). In line with a study conducted in Italy in 2024, patients seeking compensation for physical harm reported that they experienced communication issues with their physicians. They stated that they had not been sufficiently informed and felt a lack of empathy from the doctors responsible for their care and treatment (10).
At the opposite end of the spectrum, a study conducted by a well-known attorney demonstrated that, in court proceedings, a lack of communication skills is a fundamental cause of litigation in the field of medical malpractice. As a result, he proposed that the key components of effective communication should include patient education and clear explanations to ensure that the patient understands what is going to happen and why (11).
Moreover, communication should also be viewed from the perspective of the medical team, as a preventative measure against potential malpractice cases. For medical care to be both effective and safe, all members of the healthcare team must communicate efficiently. This was highlighted in a study conducted in the United States, which revealed that poor communication between physicians contributed to patient harm in approximately 43% of cases in the field of anesthesiology and intensive care (12).
These findings reinforce the existing body of research indicating a strong connection between the quality of physician communication and the likelihood of a patient filing a complaint for alleged medical malpractice.

CONCLUSIONS
Contemporary society is built upon the provision of services by public authorities across various domains, including, of course, healthcare. While no system is perfect, recent years have been marked by sustained efforts to advance technology and improve the training of medical personnel. As previously mentioned, both physicians and patients are essential components of the healthcare system, and communication is a fundamental aspect in shaping the relationship between these two key actors.
The way in which a physician communicates with a patient may also take on legal significance, especially in cases where medical errors occur and the patient seeks to hold the professional accountable. For this reason, current research recommends that healthcare professionals adopt a sincere, transparent, and clear approach when interacting with patients. By following such conduct, the likelihood of facing a malpractice complaint is significantly reduced. This has been demonstrated through scientific studies conducted on various groups of physicians.
From the perspective of Romanian case law, it is important to note that courts have often considered deficiencies in physician–patient communication to be a key factor when assessing the conduct of medical professionals. This aspect also becomes relevant when evaluating whether the standard of professional diligence has been met by the healthcare provider.
The medical profession is a complex one; it goes beyond the simple administration of treatment. Patients are human beings in need of empathy and professionals who can help them understand the medical issues they are facing. Using terminology that avoids excessive medical jargon can contribute to improved comprehension of the diagnosis and foster greater trust in the physician.
Therefore, it can be emphasized that effective communication between doctor and patient is more than just a necessity—it is a professional obligation. The national legal framework clearly states that physicians must exercise diligence in how they communicate with patients. As highlighted, this duty does not apply solely to general practitioners, but also to dentists and all other members of the medical team.
Preventing litigation should be a responsibility assumed by every physician. Legal proceedings are often difficult to manage, consuming time, financial resources, and emotional energy. Numerous studies have shown a strong connection between the fear of being sued and professional burnout. All of these challenges can be mitigated through careful and compassionate patient communication.

REFERENCES
1. Haron NN, Ibrahim NA. Doctors’ Comunication Style: Impact on patients participation.
Jurnal Teknologi.2013;65(2). https://doi.org/10.11113/jt.v65.2353
2. Shilmenova AT, Otar ES. The impact of doctor-patient interaction on trust formation: a
sociological analysis. BULLETIN of the L N Gumilyov Eurasian National University
PEDAGOGY PSYCHOLOGY SOCIOLOGY Series. 2024;149(4):594–618.
https://doi.org/10.32523/2616-6895-2024-149-4-594-618
3. Cegala DJ. An exploration of factors promoting patient participation in primary care
medical interviews. Health Communication. 2011;26(5):427–436.
https://doi.org/10.1080/10410236.2011.552482
4. Brkić H, Brkić E. Legal vs social relationship between doctors and patients. DrušTvene I
HumanističKe Studije. 2022;7(1(18)):421–432.
https://doi.org/10.51558/2490-3647.2022.7.1.421.
5. Ghozali NM, Afra NC, Agusriadi ND, Suti NS. Legal consequences of medical accidents
and medical malpractice in Indonesia. The International Journal of Law, Social Science, and
Humanities. 2024;1(2):76–82. https://doi.org/10.70193/ijlsh.v1i2.159
6. Pour H, Subramani K, Stevens R, Sinha P. An overview of orthodontic malpractice
liability based on a survey and case assessment review. Journal of Clinical and Experimental
Dentistry. 2022;e694–704. https://doi.org/10.4317/jced.59785
7. Han SJ. Strategies to Reduce the Risk of Medical Malpractice Claims against Hospitalists.
Korean Journal of Medicine. 2023;98(2):73–77. https://doi.org/10.3904/kjm.2023.98.2.73
8. Djerubu D, Daar GF. Is Politeness Language Needed in the Communication between
Nurse and Patient? International Journal of Language Teaching and Learning. 2024;1(2)-101-
108.
9. Boykins AD. Core communication competences in patient-centered care. The ABNF J.
2014;25(2):40-45.
10. Lavorato MC. Doctor-patient communication as prevention of medical malpractice
litigation. European Public & Social Innovation Review. 2024;9:1–17.
https://doi.org/10.31637/epsir-2024-1157
11. Nolin CE. Malpractice claims, patient communication, and critical paths. Quality
Management in Health Care. 1995;3(2):65–70. https://doi.org/10.1097/00019514-199503020-
00009.
12. Douglas RN, Stephens LS, Posner KL, Davies JM, Mincer SL, Burden AR, et al.
Communication failures contributing to patient injury in anaesthesia malpractice claims.
British Journal of Anaesthesia. 2021;127(3):470–480.
https://doi.org/10.1016/j.bja.2021.05.030

20/10/2023

19/10/2023

Prințul Nicolae al Romaniei

16/02/2023

Good afternoon,

My name is Poroșnicu Gianina Vera and I have been a lawyer for 25 years in the Law Bar of Iași, Romania. I would like you to pay attention to a phenomenon that occurs in Romania and has taken roots locally, in Iași, in the past 5-6 years, a dangerous phenomenon that has continued to grow and has now taken uncontrollable dimensions. The American terms of yellow journalism or yellow press can be used to describe a part of it.

There are currently a few alleged journalists who are very well known in Iași, who left from a newspaper where they used the same practice, but at a lower level and who established their own newspapers, respectively 7Iasi and dezvăluirea.ro. They were later joined by the publication ReporterIs. While doing their alleged press activity, they organised themselves in an extortion racketeering group with regular activities by committing crimes such as tax evasion, blackmail, threats and harassment.

First of all, their group identifies financially powerful individuals or people with a certain social exposure who have an image and a reputation to keep. Afterwards, they write defamatory, libellous, slanderous articles about them, presenting false information, in a scandalous manner, by using rude offensive expressions, with many grammar, spelling and punctuation errors. Subsequently, they get in touch with the concerned person and, in exchange for different amounts of money, housing, jobs, services or any other benefits, as a protection fee, they delete the above mentioned articles and possibly publish positive ones.

Me, too, I have been andcontinue to be the victim of these publications. Following the first defamatory articles about me, the representatives of these publications asked me to give them the amount of 5,000 lei (almost 1,100 euros at that time) in order to stop their attack against my reputation and dignity. I considered it unacceptable to give up my rights that are protected by law, at least theoretically, and to give in to these blackmailers, which is why the press articles continued to be constantly published in the same way. Moreover, I was harassed by one of these journalists who watched my house and stalked me around the city for several months. I filed a criminal complaint against him, and there is still a criminal investigation in progress. However, a report with a proposal for dismissal was submitted, stating that the perpetrator was in exercise of his duties, pursuant to Art. 30 of the Constitution regulating freedom of expression. In such a situation, I used the means of fight I know best and I brought civil action for each article. However, until the final settlement of the cases, the articles continued to be published online and on social media platforms, producing disastrous effects on a personal level, on my family and particularly on my 17-year-old son, as well as on a professional level. I have created a name and reputation through my work and professional achievements, but unfortunately many people give up signing legal assistance agreements with me because of those articles and the false information therein.

I am extremely upset about what is happening, about the fact that these pseudo- journalists have managed so easily to make fun of my lifetime work and, moreover, of my life and of my child. Consequently, I want to continue to fight against this phenomenon which, on the one hand, discredits "the fourth power in the state" and, on the other hand, it destroys reputations, personal and professional lives, and which I consider unacceptable in a democratic society, an attack against the right to freedom of expression and the right to information.

I am not the only one targeted by this kind of press and definitely not the only one upset and complaining. Simultaneously, this phenomenon is accompanied by the group of people who cannot take it anymore and, as a result, they come forward and complain about this kind of journalism … And there are more and more people who complain about it on online platforms and brought it to the attention of authorities, but nobody does anything about it due to the poor legislation and little awareness. My manifesto is supported by these people who were blackmailed, slandered and prejudiced by similar articles and that cry for help, but no one hears.

So I tried to draw the attention to this subject and to raise public awareness, hoping that it will cause at least a decrease in the phenomenon, by writing to all the newspapers in Romania, to all the television and important journalists about it. Unfortunately, I faced refusals, either motivated by fear or justified by professional ethics, or no answer at all. Nobody wanted to investigate, to write or to talk about it, absolutely nobody was curious to find out more or to follow my initiative and draw the attention to this phenomenon. However, I believe that, beyond the excuse of deontology, the press should exercise its role of "watchdog" in this situation as well, especially since the irregularities are within it.

This message is a cry for help from me and all those who are victims of this phenomenon. I personally know other people who are willing to come forward and to talk about what happens in Romania, and particularly in Iași, people who have as well used the legal levers available, but without any result so far.

Having in view all the above, please let me know if you can contribute by taking a stand against this phenomenon of "the blackmail press", "the mercenary press", “the pseudo press" from Iasi, if there is any way we can work together to bring to the public attention what is happening and ultimately to bring about changes and reaction from the public and authorities. I am also open to any ideas or proposals from you.

Furthermore, I wrote down some thoughts as a protest against the mentioned phenomenon, which can be found in the attachment entitled “The phenomenon of the mercenary press in Iași”. If you would be so kind as to publish this article, I would be grateful for the support given to the deontology of the journalistic profession and to “the clean press” and please provide me with the link or screenshot so that I can share it further.

I am looking forward to hearing from you.

Sincerely yours,

14/02/2023

The Phenomenon of the Mercenary Press in Iaşi - A Point of View

The fall of the communist dictatorship brought unexpected freedom after 1989: the freedom of expression, a right of every citizen that could no longer be restricted. However, pursuant to Art. 30, paragraph (1) of the Constitution: "the freedom to express thoughts, opinions or beliefs and the freedom of creations of any kind (...) cannot be violated". Under the protection of this guarantee, strengthened by paragraph (2) which stipulated that “censorship of any kind is forbidden”, a strong, diverse, influential and rich mass-media flourished in Romania, which, by all means protected by law (written, spoken, image, drawn, etc.) became "the fourth power in the state" and contributed to the support of democracy and limited the inherent mistakes of the political class.

However, it was inevitable that, in addition to honest free people, moral professionals and truth defenders, the chaff would appear, "the jukeboxes" that write as they are paid, petty unscrupulous people, willing to get rich by any means, who used these principle freedoms in order to resolve their frustrations and to indulge unhindered in committing crimes. Also, pursuant to Art. 30 of the fundamental law, we have paragraph (6), a regulation that unfortunately has remained rather a desideratum than a judicial practice, where it is clearly stipulated that “the freedom of expression cannot prejudice the person's dignity, honor, private life, nor the right to the own image ”.

One of the whispered explanations given to explain the generosity of the legal system while tolerating the flagrant abuses of journalists who violated this constitutional regulation was that it was in the public interest to disclose the facts, abuses or embezzlement of dignitaries and those who, by the nature of their function, make the object of citizens' interest and vigilance. I think it has been said correctly that, if punishments had been given for articles revealing acts of corruption by politicians (who would have immediately tried to invoke "the right to the image"), this would have affected the public interest in finding out things that any ruling group would have wanted to keep hidden. This resulted in a judicial practice by which public persons, with greater or lesser dignity, could be exposed to public reproach, with or without evidence, without the perpetrators suffering anything, even if some articles violated the constitutional provisions on the dignity, honor and right to image of these persons.

However, it has been said that the long-term cause is correct and that is why even the European Court of Human Rights has expressed a position that supports the journalists' right to disclose even when direct evidence could not be shown.

Nevertheless, in the name of the freedom of expression and a supposed public interest, can anything be tolerated? Psychological aggression, defamation, blackmail and generally the unimpeded proliferation of slander, lying, instigation of moral lynching or even explicit violence, as we see horrified in dozens of newspapers and television shows, can be excused so that journalists can be a privileged category, above law, truth, honor and morality? And can anyone really be assimilated to the professional, honorable and courageous category of journalists?

Like many other innocent citizens, without dignity and without the quality of a public person (as regulated by the law), I, a law practitioner in the liberal legal profession, have been constantly harassed, threatened, soiled, slandered, insulted and assaulted as a woman, as an honorable citizen and as a professional by people who claim to be “journalists” and who use public communication platforms for the dissemination of their “pamphlets” and who have doubtful employers and funding sources. Is this "the freedom of expression"? Let me also remind you that the financial supervision institutions of the state as well as the criminal ones should have investigated the income sources and the financial obligations of these instruments of slander, propaganda and fake news, in accordance with paragraph (5) of the mentioned Art. 30 by which the law “may impose on the mass media the obligation to make public the funding source”, whereas paragraph (8) clearly establishes who is civil responsible for "the information or creation brought to public knowledge". Besides, I was so amazed to discover that I was not the only victim of this online gang. The same thing occurred to my fellow lawyers and public persons in Iasi (I already have a detailed file with screenshot on this topic) and they were forced to pay considerable amounts of money as "a protection fee" to this criminal group that blackmailed them in the media, being also the target of a journalistic campaign whose false "revelations" pursued not the public interest, but extortion. This is undoubtedly premeditated repeated harassment.

What is there to be done having in view that the journalistic activity is not regulated by clear laws and there are no legal consequences for the ones who knowingly violate the provisions of the Journalist's Ethics Code elaborated by the Convention of Media Organizations in Sinaia in July 2004? For the ones who read tabloid publications in Iasi, on paper or only online, it is impossible to find any trace of respect for the inviolable human rights stipulated in international conventions that were agreed by Romania, too. Where are the honest journalists from these publications who should do their jobs according to the above mentioned Professional Conduct Code that obliges them to comply with the following moral and professional obligations:
2.1.1. The journalist is obliged to respect the presumption of innocence.
2.1.2. The journalist is obliged to respect the person's private life.
2.1.3. The journalist is obliged to take into account the minor' s legitimate interest.
2.1.4. The identity of the victims of accidents, calamities, crimes, especially of sexual assault, must not be disclosed.
2.1.5. The journalist has the obligation not to discriminate against any person on grounds of race, ethnicity, religion, gender, age, sexual orientation or disability and not to incite to hatred and violence.

However, these provisions are only for the ones who do this job with professionalism, good faith and morality. They are not taken into account by media offenders for the simple reason that their violation does not lead to any concrete legal effect. Criminal investigation bodies are reserved about such cases and do not always take action because "it is not possible to prove bad faith" (?), when, in fact, they do not want to "see their names in the press" and they avoid exposure, whereas justice is done by the law, according to the evidence in the case, but also according to the judge's own conscience, as we know very well. However, there are convictions and civil lawsuits won against this type of journalists, but their number is far too small in comparison to the real dimensions of the phenomenon. Moreover, such characters who defy the noble profession of journalist usually make sure that they get divorced, they transfer their assets on somebody else's name, they have no legal employment contracts whereas their employers are hidden, as well as the funding sources, so that a civil lawsuit of moral compensation leads nowhere whereas the guilty ones simply come before the bailiff without anything that could be confiscated and capitalized. Until the legislator finds it appropriate to turn the financial obligations of those found guilty into mandatory working days for the benefit of the community, this issue will not disappear, whereas the press slanderers will be free to continue their degrading activity and to ruin the good reputation and the essential social function of the press.

I'm thinking, half jokingly and half seriously, of making a newspaper online and, in this newly acquired capacity as a "journalist", I will publish weekly the "beautiful" words that were sent to me by the slanderers. But, this time, I will address them to the ones who forgave them, through the lack of reaction of the authorities who considered that the deviant behaviors were the exercise of the right to free speech and their scandalous and unproven statements as "pamphlet" or "information of public interest" , or the ones who encouraged them, by financially supporting the phenomenon.

What if? It is a topic that the public opinion should take seriously, and I believe that it should be debated in order to stop these offensive and toxic practices that infest our civilization and democratic atmosphere, inciting to hatred and violence. Paragraph (7) of the said Article 30 of the Constitution states that: “It is forbidden to slander the country and the nation, to incite to war of aggression, to national, racial, class or religious hatred, incitement to discrimination, the territorial separatism or public violence, as well as obscene manifestations contrary to good manners”.

Authoress,
Lawyer Poroşnicu Gianina Vera
Law Bar Iași

1 See https://www.paginademedia.ro/2010/05/codul-deontologic-al-jurnalistului-elaborat-de-conventia-organiza- tiilor-de-media/ accesată pe 05.04.2021

06/05/2021

In the following article, I present to you a point of view on the freedom of the press and clear references to the phenomenon called "mercenary press", "gutter press", "yellow press", "blackmail press", "pseudo press", "dirty press", "Lying press."

https://en.porosnicugianina.ro/en/category/articole/-the-phenomenon-of-the-mercenary-press-in-iai-a-point-of-view-

The fall of the communist dictatorship brought unexpected freedom after 1989: the freedom of expression, a right of every citizen that could no longer be restricted. However, pursuant to Art. 30, paragraph (1) of the Constitution: "the freedom to express thoughts, opinions or beliefs and the freedom...

24/03/2021

Fake news is a phenomenon that is growing exponentially due to globalization and digitalization.

During an information campaign for children, lawyer Gianina Vera Poroșnicu debates the subject of fake news, the effects and possible actions to prevent and fight it, in the show Recreația Mare, on Infinit TV.

The entire material on fake news can be viewed here: https://www.porosnicugianina.ro/fake-news-efecte-prevenire-si-combatere
The source of the material and the entire episode of the show can be viewed here: https://www.facebook.com/InfinitTv.ro/videos/897068317533544