How does the pediatrician achieve acceptable levels of patient satisfaction, build effective relationships and avoid malpractice lawsuits? Researchers have theorized that poor communication between physicians and their patients may be a major contributing factor in deciding why patients initiate a lawsuit. The average annual rate of professional liability claims in 1996 was 9 per 100 Physicians, according to the American Medical Association Center for Health Policy Research. Often a patient's decision whether or not to sue is based on the nature of the therapeutic relationship with the physician prior to the negative event. The communication process is central to the relationship and takes on added importance because it can affect the outcomes of medical care such as patient satisfaction, compliance and even the physiological responses to care. The literature suggests that a strong bonding with patients and the development of friendly relationships can serve as deterrents to malpractice exposure.