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Early action against ‘complaint-prone’ doctors may help protect patients

Surgery and psychiatry attract the most patient complaints and have a high potential for power imbalance. c e d db o/Flikr

Nearly a fifth of all complaints against doctors in private practice in Victoria are made against a small group of medical professionals.

So taking early action against these complaint-prone doctors may help improve patient satisfaction and public confidence in health services.

In Australia, complaints are received by health complaints commissions, which play a vital role in protecting patients’ rights within the health-care system.

They resolve thousands of complaints each year and have become the primary avenue for medico-legal redress.

Complaint-prone cluster

Our research looked at more than 3000 complaints against doctors in private practice made to the Victorian Health Services Commissioner in the decade to 2010.

The aim was to try to understand whether complaints are just “luck of the draw” or whether certain groups of doctors are more complaint-prone than others.

We found that complaints clearly cluster around certain doctors. While most doctors appear to be at minimal risk of multiple complaints, a small group account for a disproportionate number.

In our analyses, less than 100 practitioners, or 1% of doctors in private practice in Victoria, accounted for nearly 20% of complaints to the commissioner.

Each of these doctors was the subject of four or more separate complaints over the study period.

Common characteristics

Compared with doctors subject to one isolated complaint, the core of 96 complaint-prone doctors were more likely to be male, surgeons or psychiatrists, and to have been in practice for at least 30 years.

These findings are consistent with previous studies of lawsuits, disciplinary actions, and compensation claims, which have also identified surgery and psychiatry as high-risk specialties for medico-legal action.

The reasons are unclear, although in surgery the inherent risks of surgical procedures and the relative visibility of poor outcomes of care are likely to play a role.

And, in both surgery and psychiatry, the potential for power imbalance is high.

We also found that international medical graduates were less likely than locally trained doctors to be the subject of multiple complaints.

But how much this finding can be generalised is questionable as a recent report from the United Kingdom indicates a higher rate of referral to the National Clinical Assessment Service for non-white doctors and doctors who qualified outside Europe.

Predicting future complaints

The findings that large numbers of complaints are concentrated on a small group of doctors, and that these doctors exhibit distinctive characteristics, has important policy implications.

Case-by-case complaints resolution processes largely overlook the importance of past complaints as a predictor of future complaints.

Such processes also end up spreading commissions’ resources rather thinly across all complaints.

Intervening with high-risk doctors could help commissioners build a stronger fence at the top of the cliff – by protecting patients from future harm – rather than serving as an ambulance at the bottom.

With the support of the health commissioner in each state and territory, we are planning a two-year national study of health-care complaints.

Our goal is to develop a screening tool to assist commissioners flag high-risk doctors early in their complaints trajectory.

Ideally, interventions would be directed towards specific areas of complaint, such as communication, informed consent, or quality of care, and tailored according to the seriousness of concerns and the doctor’s past history.

Concerns could then be addressed in a timely way, which may help improve patient satisfaction and reduce the risk of future complaints.

This article is based on research published in the Medical Journal of Australia. The research was awarded the 2011 Gerry Murphy Prize by the Royal Australasian College of Physicians.

Do you think early intervention could help complaint-prone doctors provide better patient care? Leave your comments below.

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