Health commissions and medical boards should publicly disclose the details of complaints against doctors when multiple allegations of misconduct or inappropriate behaviour are made, experts say.
The call comes as a study shows half (49%) of patient complaints to health commissions against doctors in Australia are made against just 3% of doctors. The research is published today in the journal BMJ Quality and Safety.
Headed by University of Melbourne senior research fellow Marie Bismark, the researchers examined a sample of 18,907 formal patient complaints against doctors filed with a state or territory-based health service ombudsman over the past 11 years.
Around 60% of complaints were about the quality of care that was provided, such as medication errors or unexpected complications.
One-quarter of the complaints were about a communication issue, such as not having given informed consent, finding the doctor rude or arrogant, or not having their questions answered.
“Patient-doctor communication is a really common cause of patient complaints, and it’s often in a combination of the two – that something would have gone wrong clinically, and on top of that, the patient will have been concerned about the way that the doctor responded,” Dr Bismark said.
Some medical specialities were at higher risk of complaints, such as plastic surgeons, orthopaedic surgeons and obstetricians and gynaecologists. Psychiatrists had a slightly higher risk of recurrent complaints and general practitioners ranked somewhere in the middle.
Dr Bismark said the next step was to work out how to translate these findings into something commissioners would use in their day-to-day work.
“The kind of thing we’re thinking about is perhaps a reasonably simple scoring system where, when a complaint is received, you would be able to characterise a doctor and really triage them as to whether they are at high risk of recurrent complaints or whether this is just somebody who has just received one or two isolated complaints,” she said.
In an accompanying editorial in BMJ Quality and Safety, Professor of health law and policy at the University of Auckland, Ron Paterson, outlined a potential solution: when a doctor has three patient complaints made against him or her within three years, commissions and medical boards should publicly name the doctor and the nature of the allegations.
“We need to bring these frequent flyers to the attention of the public,” Professor Paterson said.
“These are patients who are being harmed or, if they’re not being physically harmed, they’re receiving an inappropriate standard of care or communication.”
Professor Paterson worked as New Zealand’s health commissioner from 2000 to 2010.
Only one in 25 New Zealanders made a complaint when they had a problem with a doctor, he said.
“Most people don’t go through the bother of making a complaint at all, let alone a complaint to the external commissioners. So the doctors who end up being subject to multiple complaints are significant outliers – there is something going on here.”
Professor Paterson said there needed to be processes in place to ensure the system was fair, such as ensuring the three complaints were not from the one person, that there was no evidence of collusion and that the doctor had an opportunity to comment.
But under his proposal, the complaints would not have to be formally proved.
“Under our current systems, very few complaints are ever proved as complaints, in the sense that very few go to a formal investigation with formal findings,” he said.
“If you were to introduce a system where every complaint has to be formally proved, you will tie the whole system up in knots.”
Associate Professor Moira Sim, from Edith Cowan University, said the idea had merit, and would be preferable to a system where all doctors were subjected to re-certification to ensure they provided quality care.
“I’m a strong believer in targeting action where the problem lies rather than across the board, wasting efforts and resources,” she said.
But the issue of fairness in naming an accused doctor would need to be addressed, she said.
“One could look at a system where those who have three complaints in three years are assessed by a committee and those for whom the complaints have validity then become public.
"We have to have fair ways of assessing this, with health professionals, consumers and managers of organisations being part of the assessment of the claims.”