Clinical Review & Education

JAMA Surgery | Review

Association of Emotional Intelligence

With Malpractice Claims
A Review
Daniel Shouhed, MD; Catherine Beni, MD, PhD; Nicholas Manguso, MD;
Waguih William IsHak, MD; Bruce L. Gewertz, MD

IMPORTANCE Approximately 8% of physicians experience a malpractice claim annually. Most

malpractice claims are a result of adverse events, which may or may not be a result of medical
errors. However, not all medicolegal cases are the result of medical errors or negligence, but
rather, may be associated with the individual nature of the patient-physician relationship.
The strength of this relationship may be partially determined by a physician’s emotional
intelligence (EI), or his or her ability to monitor and regulate his or her emotions as well as the
emotions of others. This review evaluates the role of EI in developing the patient-physician
relationship and how EI may influence patient decisions to pursue medicolegal action.

OBSERVATIONS Several physician characteristics are associated with increased medicolegal

risk. Some of these traits, such as sex, age, level of experience, and specialty, are inherent.
Other characteristics, such as patient interaction, patient satisfaction, and prior legal history,
appear to be related to physicians themselves, yet they are modifiable if such physicians can
be identified. Numerous tools exist that provide general measures of different aspects of EI.
Furthermore, identification of those with lower EI and intervention with specific training has
been shown to improve both EI and patient satisfaction.
Author Affiliations: Department of
Surgery, Cedars-Sinai Medical Center,
CONCLUSIONS AND RELEVANCE The study and effect of EI within medicine offers great Los Angeles, California (Shouhed,
opportunity to investigate how physician characteristics may influence one’s EI, as well as Manguso, Gewertz); Department of
Surgery, University of Washington,
medicolegal risk. This review suggests an indirect negative correlation between a physician’s
Seattle (Beni); Department of
level of EI and his or her risk of litigation. Studies directly linking physicians with low EI to Psychiatry, Cedars-Sinai Medical
a higher risk of litigation are lacking and may provide valuable insight. Demonstrating such Center, Los Angeles, California
a correlation should prompt the development of interventions that may enhance a physician’s (IsHak).
level of EI early in his or her career and may limit future legal action. Corresponding Author: Daniel
Shouhed, MD, Department of
Surgery, Cedars-Sinai Medical Center,
JAMA Surg. doi:10.1001/jamasurg.2018.5065 8635 W Third St, Ste 650-W,
Published online January 30, 2019. Los Angeles, CA 90048
(daniel.shouhed@cshs.org).

T
he risk of medical malpractice litigation is a reality that no
physician can completely escape. It is estimated that ap-
proximately 8% of physicians experience a malpractice
claim annually.1,2 Opinions have been expressed that fear of litiga-
tion leads to physicians’ reluctance to treat patients with complex
conditions, earlier physician retirement, and migration away from
certain fields, such as surgical specialties.3 Furthermore, the threat
of a lawsuit undesirably encourages the ordering of additional tests
or services in an attempt to preempt any possible medicolegal ac-
tion (“defensive medicine”).4,5 Such actions place a substantial eco-
nomic burden on the US health care system, generating an addi-
tional cost of $45 billion annually, or about 5% of total health care
costs.6-8
Medical Malpractice and Adverse Events
Adverse events may or may not be the result of medical errors. Many
of these errors reflect systemic deficiencies in the complex environ-
ment of health care and, by that rationale, all health care profes-
sionals are similarly affected. Many hospitals are developing increas-
ingly sophisticated systems designed to prevent adverse events from
occurring.9 However, despite substantial system improvements, hu-
man nature ensures that errors can never be eliminated; there will
always be an intrinsic risk of complications, especially with invasive
operations. Naturally, surgeons have a higher rate of litigation than
other physicians because of the potential for complications during
operations.3,10-14 Therefore, proposing ways to predict and poten-
tially prevent complications from resulting in litigation would be of
great value to all surgeons.
Not every adverse event is associated with a lawsuit. Less than
1.5% of medical errors due to negligence lead to litigation.15,16 Fur-
thermore, it is generally accepted that there are important social and
demographic determinants for the initiation of a lawsuit and that the
quality of the patient’s or family’s relationship with the physicians
involved is critical,17,18 which raises the question of how a lawsuit may

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 Clinical Review & Education Review
be prevented once an adverse event occurs. What determines a pa-
tient’s decision to sue? Is it the severity of the complication, the
nature of the patient-physician relationship before the problem, or
how the physician addresses the complication?
There is a growing body of literature showing that a minority of
physicians generates the majority of malpractice lawsuits, and that
physician characteristics are the most important drivers for law-
suits. In one report by Studdert et al,10 1% of physicians accounted
for 32% of paid malpractice claims. Although objective character-
istics, such as medical knowledge, decision making, and technical
skill, are crucial to molding a great physician, the so-called softer skills,
such as interpersonal and communication skills, remain elusive and
are often overlooked in education and training. The overall assess-
ment, measurement, and improvement of these other critical skills
fall into the realm of emotional intelligence (EI).
Emotional Intelligence
Emotional intelligence is defined as an individual’s ability to moni-
tor and regulate his or her emotions as well as the emotions of
others.19,20 Emotional intelligence encompasses the full range of
interactions between individuals and society, including self-
awareness, social awareness, self-regulation, and situational
management.21 Clinicians with high EI possess empathetic capabili-
ties of putting the patient at ease by authentically validating their
pain, experiences, or loss and providing genuine understanding and
comfort.
The popular acceptance of EI was furthered by Goleman22 in
his classic 1998 essay “What Makes a Leader?” It is now widely rec-
ognized that the concepts Goleman22 articulated reflect a practical
distillation of a “mixed model” for EI, incorporating both “trait EI”
and “ability EI.” Trait EI, articulated in 2001 by Petrides and
Furnham,23 is evaluated by one's own reporting and involves one's
innate behaviors and abilities. Trait EI is thought to best assess
how individuals perceive and regulate their own emotions and
sustain themselves during stress or conflict. Ability EI, defined in
1990 by Salovey and Mayer,20 instead describes the ability to logi-
cally understand emotions and to use them to strengthen percep-
tion and thought. That is, ability EI characterizes an individual’s
ability to process emotional information (often expressed by oth-
ers) and how well he or she uses this insight to navigate different
social environments.
Two tests are available to measure trait EI: The Trait Emo-
tional Intelligence Questionnaire (TEIQue) and the Wong and Law
Emotional Intelligence Scale (WLEIS). The TEIQue, created by
Petrides,24 is a self-report measure recognized for its ease of
comparison with the popular and intuitive Goleman model. The
TEIQue is limited by being a self-reported test, leaving open the
possibility of dishonesty or simply unconscious selection of more
socially desirable responses. This limitation may be addressed by
the TEIQue 360, in which a test taker’s peers and relatives are
also asked for input. The WLEIS was developed as a rapid self-
reported test to assess trait EI.25 It is focused on predicting lead-
ership capacity among managers.26-29
The Mayer-Salovey-Caruso Emotional Intelligence Test
(MSCEIT) is the primary assessment tool for ability EI. Although it
has good reliability on its own, its validity is extrapolated from a
previous version, the Multifactor Emotional Intelligence Scale.
Several researchers have expressed concerns about the absence
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Association of Emotional Intelligence With Malpractice Claims
of scientific standards for determining the accuracy of consensus
and expert scores, in addition to concerns about how experts are
chosen.26,30 To address some of these concerns, a newer version
of the Mayer-Salovey-Caruso Emotional Intelligence Test, the
Mayer-Salovey-Caruso Emotional Intelligence Test version 2, has
recently been developed and its predictive abilities are currently
being assessed.31
There are 2 widely referenced mixed models of EI, each with an
associated evaluation tool: the Goleman model, assessed by the
Emotional Competence Inventory, and the BarOn model, mea-
sured by the BarOn Emotional Quotient Inventory. Both have been
validated but also have their limitations. Very few independent, peer-
reviewed assessments of reliability and validity of Emotional Com-
petence Inventory have been published owing to proprietary re-
strictions. As a consequence, the Emotional Competence Inventory
has not been considered as a serious scale for measurement and as-
sessment of EI and is not favored by researchers.26,27 The BarOn
Emotional Quotient Inventory is another self-reported measure,
which has limitations similar to those seen in the WLEIS, in that its
predictive capabilities are primarily accounted for by other per-
sonal factors beyond EI, such as cognitive ability and personality
traits26,32,33 (Table).24-27,31-33
It is our hypothesis that the intrinsic EI of a physician—and the
ability to deliver emotionally responsive care—plays a prominent role
in molding the patient-physician relationship and, hence, strongly
influences a patient’s decision to pursue medicolegal action. In this
article, we seek to identify and better understand this connection,
and additionally, aim to demonstrate the potential for EI to serve as
a metric for medicolegal risk. To do so, we will present the com-
mon, objectively measurable characteristics of physicians as they ap-
ply to the risk of litigation; the influence of EI on physician perfor-
mance and patient satisfaction; and the role EI may play in mitigating
the risk of litigation within the field of medicine.
Methods
Search Strategy
We conducted a literature search of articles in the MEDLINE, Psy-
cINFO, and Cochrane Database of Systematic Reviews databases
from their inception to January 2017 using the following key words:
emotional intelligence, emotion, malpractice, legal, demographics,
and medic*. The following additional search terms were used to bet-
ter characterize the effect of demographics: age, gender, and spe-
cialty. In performing this review, we followed the guidelines of the
Preferred Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA).34
Study Selection Criteria and Methods
Two of us (D.S. and C.B.) independently reviewed the abstracts of
each article retrieved using the following inclusion criteria: (1) ar-
ticles that were in English or had an available published English trans-
lation, (2) articles that were published in a peer-reviewed journal,
and (3) only primary literature and review articles. We refined our
search by excluding articles focusing solely on ancillary medical staff,
patients, team-based practice, psychology, or leadership. Addi-
tional articles meeting the selection criteria were added from the ref-
erence lists of the collected articles.
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 Association of Emotional Intelligence With Malpractice Claims Review Clinical Review & Education

Table. Emotional Intelligence (EI) Evaluation Methods

Test Name Measurement Method Competencies Measured EI Model Reliability Validity Limitations
Trait Emotional Self-reported Well-being, self-control, Trait Excellent Excellent Self-reporting leads to dishonesty
Intelligence emotionality, and sociability and unconscious selection
Questionnaire24
Wong and Law Self-reported Self-emotional appraisal, Trait Limited Limited Significant overlap with other
Emotional others’ emotional appraisal, personality tests
Intelligence Scale25 self-regulation of emotion,
and emotion to facilitate
performance
Mayer-Salvovey-Caruso Consensus scoring and Perception, understanding, Ability Good Extrapolated Absence of scientific standards
Emotional Intelligence expert scoring knowledge, and management from other for determining the accuracy of
Test31 of emotions tests consensus and expert scores
Emotional Competence Self-rating, peer rating, Self-awareness, social Mixed Limited Limited Very few peer-reviewed
Inventory (ECI)26,27 and supervisor rating awareness, self-management, assessments of reliability and
and social skills validity because of proprietary
restrictions
BarOn Emotional Self-reported Intrapersonal, interpersonal, Mixed Good Good Five competencies are not
Quotient adaptability, general mood, properly weighted; its predictive
Inventory26,32,33 and stress management capabilities are accounted for by
other personal factors beyond EI

Data Extraction and Yield
Research methods and key findings were derived from the full text
and tables of the selected studies. Study design and findings are
detailed in the Table.
be more likely to take on patients with more complicated condi-
tions. Furthermore, a lower claim rate during the early years of a prac-
tice may simply be because a physician has fewer patients. Practice
location, type, and care hours did not significantly affect the risk
of malpractice.

Litigation and Physician Characteristics

Results
Litigation and Physician Demographics
Our search totaled 49 articles. Many factors play a role in the risk of
a physician incurring a malpractice claim, including medical spe-
cialty, age, sex, and education. Six studies demonstrate that the sur-
gical specialties (neurosurgery, orthopedic surgery, general sur-
gery, and obstetrics and gynecology) are consistently associated with
an increased risk of any malpractice claim.3,10-14 These fields incur
a risk of malpractice 5 to 12 times that of fields such as internal
medicine, pediatrics, and psychiatry. The simplest explanation is
that surgeons incur more malpractice claims simply because they
perform operations, and each operation bears an innate risk of
complications.3,11 Board certification, class rank in medical school,
and prestigious credentials had no association with the risk of a mal-
practice claim.3,12
Male sex has been associated with an increased risk of medico-
legal action.10,11,13,35 Male physicians experience almost a 3 times
higher risk of having 1 malpractice claim11 and 1.5 times risk of hav-
ing subsequent claims.10 This increased risk may be associated with
the way that men and women differ in their patient interactions.
Women consistently demonstrate higher ratings in humanistic
qualities36 and patients, in general, experience greater satisfaction
after interacting with female physicians.37,38
Intuitively, one may expect younger physicians to have an in-
creased risk of malpractice because of their inexperience. Surpris-
ingly, multiple studies reveal that middle-aged physicians (age 40-50
years) experience the highest risk of incurring a malpractice
claim.10-12,39 This observation may be skewed by the fact that a sub-
stantial number of physicians younger than 40 years are still com-
pleting their training, especially in surgical specialties. In addition,
an awareness of their own inexperience may lead younger physi-
cians to be judicious in selecting patients for procedures. As years
pass and a physician’s practice and experience grow, he or she may
Four studies showed that physicians with previous malpractice claims
are at substantially increased risk of future claims.3,10,40,41 This as-
sociation appears to be straightforward: one expects that physi-
cians who have made clinical errors severe enough to warrant a mal-
practice lawsuit would have clinical habits that may place them at
risk for subsequent errors. Yet the payment amount of previous
claims appears to have little association with the risk of future mal-
practice claims; even a single prior unpaid malpractice claim almost
doubles the risk of any future claims.40 This finding reinforces those
of Taragin et al,42 who showed minimal variability in award and
“indefensibility” rates when controlling for the severity of the clini-
cal error.
In an effort to identify this propensity, 3 studies focused on
the link between unsolicited patient complaints and risk of
malpractice.43-45 Hickson and colleagues43 showed a direct posi-
tive correlation between the number of complaints generated against
a physician and the number of medicolegal events incurred. Their
study also demonstrated that a minority of physicians generates the
majority of patient complaints: 9% of physicians in their study group
incurred 50% of all patient complaints. Bismark and colleagues44
replicated these findings in a study of Australian physicians; 3% of
physicians in their cohort accounted for 49% of all complaints. Their
study further showed that physicians who generated unsolicited
complaints were more likely to incur subsequent complaints.
Finally, physicians with low patient satisfaction ratings have a sig-
nificantly increased risk of malpractice suits brought against them
compared with physicians with high patient satisfaction ratings. Phy-
sicians in the lowest tercile of ratings experienced malpractice rates
110% higher than their colleagues in the highest tercile.45
Although it is plausible to speculate that patient complaints are
generated because of a lack of adequate medical care or poor clini-
cal performance, several studies have shown that physicians with
the highest number of lawsuits are more likely to experience pa-

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 Clinical Review & Education Review
tient complaints of a more personal nature. The litigated physi-
cians were identified as being rude or disrespectful, did not return
telephone calls, and did not listen to the patient.18,46-48 Specific com-
municative behaviors of physicians have been linked to increased
risk of malpractice. For example, patients reported increased dis-
satisfaction if the physician failed to elicit an opinion from the pa-
tient or family or to discuss the effect of a medical problem on the
patient or family.18,46,47,49,50 Levinson and colleagues51 found that
physicians without malpractice claims were more likely to spend
more time with patients during a visit, seek patients’ opinions, and
use humor regularly than were physicians with malpractice claims.
The style of communication and tone of voice also play an impor-
tant role. Removing content entirely and analyzing solely the tone
of voice, one study demonstrated that surgeons speaking to pa-
tients with dominant, unconcerned tones were almost 3 times as
likely to have experienced medicolegal events as their peers with
tones of voice perceived as less domineering.52 When combined with
dominance, the lack of anxiety in a physician’s voice may imply in-
difference toward a patient, leading to erosion of any trust be-
tween the physician and the patient. This could lower the thresh-
old to pursue medicolegal action should an adverse event occur. In
summary, 6 studies focused on specialty,3,10-14 4 studies focused on
sex,10,11,13,14 2 studies focused on education,3,12 4 studies focused on
age,10-12,39 2 studies focused on previous malpractice claims,3,10
3 studies focused on patient complaints,43-45 and 7 studies fo-
cused on patient communication.18,46-48,50-52
EI and Physician Demographics
We found only 1 study that directly examined the link between EI
and physician specialty. McKinley et al53 measured the EI of 139 resi-
dents in pathology, pediatrics, and surgery using the TEIQue. When
compared with the nonphysician population, resident physicians as
a group scored higher in impulse control, emotional management,
empathy, self-motivation, and self-esteem but scored lower in so-
cial awareness and adaptability. Only sociability factor, consisting of
the subscales assertiveness, emotion management, social aware-
ness, adaptability, and self-motivation, varied significantly among
the specialties. Residents in pathology scored lower in optimism and
emotion management than both surgical and pediatric resident phy-
sicians, and lower in social awareness than surgery resident physi-
cians. Although these results are consistent with popular beliefs of
the unique personalities of physicians in particular specialties, the
study is limited by its low response rate, particularly among surgi-
cal resident physicians.
At this time, the correlation between EI and clinician age is un-
clear. Two studies have found a modest trend toward increasing EI
with age or experience (R2 between 0.043 and 0.17),53,54 while
2 show no such association.55,56 When expanded to include noncli-
nicians, 1 study has shown a small positive correlation between EI
and age among undergraduate students,57 while another shows a
decrease in EI with age among medical students.58 The finding that
EI increases with age is consistent with the fact that personality traits
evolve with age, particularly with most people increasing in consci-
entiousness and agreeableness.59
Sex has been consistently shown to play a role in EI among medi-
cal professionals.56,58,60-63 Women tend to score higher than men
in global EI58,61-63 but lower than men in the specific facets of stress
management and emotion management.60 These findings are
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Association of Emotional Intelligence With Malpractice Claims
consistent with those of other studies showing that women clini-
cians demonstrate more favorable humanistic characteristics and
greater patient satisfaction scores, as assessed by other medical
professionals36 and patients.38
EI and Physician Performance
Elevated stress levels have already been implicated as a key con-
tributor to poor teamwork and disruptive physician behavior.64
Disruptive behavior is not merely a nuisance to colleagues; it di-
rectly jeopardizes patient safety, wears away at the morale of other
health care professionals, and disrupts the patient-physician
relationship.65,66 These behavioral symptoms of stress will likely per-
sist unless physicians and institutions as a whole develop resilient
coping tools.67
Accurately understanding and regulating one’s own emotional
response plays a critical role in how an individual approaches stress-
ful situations and counteracts the effects of stress and burnout.68,69
Reported research to date strongly suggests that individuals with
higher EI are better at coping with stressors and mitigating burn-
out than are individuals with lower EI. Several studies of frontline
health care professionals have shown that EI is positively corre-
lated with both increased recognition of stress and stressors in the
workplace and lower rates of depression and greater organiza-
tional commitment.68,70,71 Among resident physicians, higher lev-
els of EI have been correlated with lower levels of burnout.68
Arora et al69 analyzed the effect of EI on stress among resi-
dents performing surgical tasks. Although higher EI was associated
with higher levels of subjective and objective measures of stress dur-
ing the procedures, it also correlated positively with improved stress
management and more rapid recovery times. Trait EI correlates posi-
tively with perceived stress but negatively with feelings of burnout.68
These findings reinforce the connection between heightened aware-
ness of stressors and an increased ability to return to baseline after
exposure to stressors.
EI and Patient Satisfaction
Studies54,56,72,73 have shown a positive association between higher
EI scores and patient satisfaction in the outpatient setting.54,57 Using
the WLEIS, the Jefferson Scale of Physician Empathy, and patient
satisfaction questionnaires, Weng and colleagues72 found a statis-
tically significant positive correlation between attending surgeons
with higher EI scores and patient satisfaction in the preoperative pe-
riod. Surgeons’ EI had no significant correlation with patient satis-
faction in the postoperative period.
Dugan et al73 also assessed the link between EI and patient sat-
isfaction. Using the BarOn Emotional Quotient Inventory to mea-
sure the EI of resident and attending physicians in otolaryngology
across several years, they identified physicians with lower than
average EI scores. These physicians underwent an EI training pro-
gram, after which they showed an improvement in their overall
EI scores. More important, patient satisfaction with the care pro-
vided by these physicians showed a significant increase from
before the intervention to after the intervention. Although these
findings suggest that an individual’s measured EI can change, it
is not clear at this time whether their intrinsic capacity is being
expanded or simply more expertly accommodated for. In
summary, 1 study focused on specialty,53 4 studies focused on
age,53-56 6 studies focused sex,56,58,60-63 4 studies focused on phy-
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 Association of Emotional Intelligence With Malpractice Claims
sician performance, 68-7 1 and 4 studies focused on patient
satisfaction.54,56,72,73
Discussion
Emotional intelligence is currently used as a predictive tool of
achievement in fields ranging from finance to sports. With the greater
level of accountability in medical practice, there has been interest
in better understanding the role EI plays in physician performance.
Emotional intelligence could be considered a valuable assessment
of the social context of medicine: a quantitative tool by which we
can measure the complex factors that go into the interactions be-
tween physicians, colleagues, and patients.
Although there have been few, if any, studies that directly
examine the association of physician EI with malpractice claims,
our analysis shows that numerous connections can be made indi-
rectly between EI and risk of malpractice claims. Our review shows
that there are important physician characteristics that demon-
strate predictable correlations with both EI and the propensity to
be involved in litigation. There is consensus that many of these
characteristics place a physician at increased risk of litigation. Sev-
eral of these characteristics can be easily assessed: namely, age,
sex, and specialty. Other characteristics are more indicative of
the quality of a physician’s interpersonal interactions: patient satis-
faction ratings, patient complaints, and any prior history of legal
action. Physicians with any kind of negative interactions—low
satisfaction ratings, increased patient complaints, or a previous
lawsuit—are at a disproportionately higher risk of incurring
a lawsuit than their colleagues in the same specialty. This is cor-
roborated by the consistent observation that only a small number
of physicians account for the preponderance of negative
interactions.43
There are similar associations between these physician charac-
teristics, behaviors, and the evolution of EI. Emotional intelligence
trends higher and malpractice risk trends lower with increasing age,
female sex, and the practice of nonsurgical specialties. Emotional
intelligence has also been shown to play a substantial role in shap-
ing a physician’s interactions and communication with patients, with
physicians with higher EI scores consistently showing an increase
in patient satisfaction. Hence, it is reasonable to assume that the
strong role EI plays in the quality of a physician’s social and profes-
sional interactions may parallel its considerable influence in deter-
mining a physician’s risk of litigation.
Proving this hypothesis would first require creation of a vali-
dated, medically specific tool that would enable the objective
measurement of a physician’s EI. Although several validated tools,
such as the TEIQue and WLEIS, are in use today, these question-
naires lack any reference to patient care or colleague interaction
within the realm of medicine and may not accurately capture the
complex social aptitude involved with difficult patient interac-
ARTICLE INFORMATION Author Contributions: Dr Shouhed had full access
Accepted for Publication: August 27, 2018. to all the data in the study and takes responsibility
for the integrity of the data and the accuracy of the
Published Online: January 30, 2019. data analysis.
doi:10.1001/jamasurg.2018.5065 Concept and design: Shouhed, Beni, IsHak,
Gewertz.
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Review Clinical Review & Education
Figure. Emotional Intelligence Litigation Flowsheet
Latent failure (systemic errors) Active failure (individual errors)
• Management • Technical skill
• Systems design • Decision making
Adverse event
Risk management Emotional intelligence
Litigation
Adverse events are the result of both active and latent failures and errors.
Adverse events may or may not result in litigation, depending on the level of risk
management and a physician's emotional intelligence.
tions, which occur on a day-to-day basis. Developing and imple-
menting a physician-specific tool may allow for the detection of
practitioners with low EI, allowing for early intervention for these
physicians. Ideally, this intervention would improve patient satis-
faction, decrease patient complaints, and reduce litigation
(Figure).
Limitations
There are several limitations within this review. Emotional intelli-
gence in the medical field has been addressed by a relatively small
number of peer-reviewed articles. Several of these articles are
focused on nonphysicians such as medical students. As a conse-
quence, we are hindered in our ability to draw concrete conclu-
sions from this limited evidence. At the heart of this constraint is
the lack of consensus on the definition of EI: is EI a personality
trait, a performance ability, or a combination of the 2? This is cer-
tainly not just a conflict in the medical literature; it is an ongoing
battle in the field of EI overall. These distinctions become espe-
cially important when proposing interventions to improve EI
among medical practitioners.
Conclusions
The study and effect of EI within medicine offers an opportunity to
investigate how physician characteristics may influence one’s EI, as
well as medicolegal risk. This review suggests an indirect negative
correlation between a physician’s level of EI and his or her risk of liti-
gation. Studies directly linking physicians with low EI to a higher risk
of litigation are lacking and may provide valuable insight. Demon-
strating such a correlation should prompt the development of in-
terventions that may enhance a physician’s level of EI early in his or
her career and may limit future legal action.
Acquisition, analysis, or interpretation of data: All
authors.
Drafting of the manuscript: Shouhed, Beni,
Manguso, Gewertz.
Critical revision of the manuscript for important
intellectual content: Shouhed, Beni, IsHak, Gewertz.
(Reprinted) JAMA Surgery Published online January 30, 2019 E5
 Clinical Review & Education Review
Administrative, technical, or material support:
Shouhed, Gewertz.
Supervision: Shouhed, IsHak, Gewertz.
Conflict of Interest Disclosures: None reported.
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