Patient complaint procedures leave doctors emotionally distressed

Complaints against doctors can impact on their psychological well being, according to a new study from Imperial College London.

The research, the second part of a study published last year into complaints against doctors, revealed in detail the emotions triggered by complaints. 

The statements from doctors about the complaint process included phrases such as: "Makes you feel worthless even when you know you've done the best you can", "It seemed as if the patient is presumed to be right, and the doctor is presumed wrong, unless you can prove otherwise."

One said: "I am fairly sure that this results in me practising poorer medicine." While another added simply: "My life was ruined."

Some medics also called for patients or colleagues to be reprimanded if a complaint is found to be unfounded or malicious.

The authors of the study, published in the journal BMJ Open, call for the complaint process to be made more transparent, and for grievances to be resolved more quickly. They also recommended a more open dialogue between patients and doctors, and for doctors to receive emotional support during the complaint process.

Professor Tom Bourne, lead author of the study, from the Department of Surgery and Cancer at Imperial, said: "Although it is absolutely right that patients’ should feel able to complain about their treatments – and that these complaints are properly investigated, this study suggests the complaint process needs improvement.”

He added: “The number of patient complaints against doctors has risen dramatically in recent years - with complaints against GPs doubling between 2007 and 2012. Yet this study suggests the complaint process causes huge distress for doctors, and may have a real impact on patient care."

The General Medical Council regulates doctors in the UK and can stop or limit their rights to practise. In 2013 there were more than 8,500 complaints about doctors to the GMC, of which just over 3,000 went on to be investigated. About 80 doctors a year are suspended or erased from the medical register. Apart from those referred to the GMC, many other complaints are investigated through hospitals’ or clinics’ internal enquiries.

The research in the current study was from a survey of over 7,000 doctors who had received a previous or current complaint. The majority of these complaints were from patients though some were from colleagues. Most complaints were dealt with internally by the doctor's hospital or clinic, though some were referred to the GMC.

To avoid bias, the researchers, who included scientists from the University of Leuven, randomly selected 1000 of these long answers, and analysed these using the 'saturation principle.' This means the researchers stopped assessing the answers when they saw the same themes emerging. This occurred after 100 responses had been analysed.

Of the 100 doctors included in the analysis of the survey, the final outcome of the complaint investigation was known for 80 doctors. Sixty-seven were exonerated, two subject to disciplinary action, one was suspended from practice and 10 were subject to an ongoing investigation.

The first results of the survey, which were published last year, revealed doctors who had experienced complaints suffered high levels of depression, anxiety and even suicidal thoughts.

In the current study, the researchers analysed data from the second part of the survey, where the doctors answered open-ended questions, and were free to write what they wished.

When asked about their experience of the complaints procedure, nearly half of the doctors felt negative feelings towards the complainant or complaint. Comments included: "I still find it very hard that a patient's family could be so vindictive and unpleasant." Many doctors described feeling impotent and helpless, whilst similar numbers described emotional distress, for example “I cry, can’t sleep and contemplate suicide and certainly not being a doctor anymore.”

The majority of doctors’ comments said procedural issues were the most stressful part of a complaint. Most commonly this was due to the feeling the process was biased in favour of the patient, or the length of time taken to investigate a complaint and the unpredictable nature of procedures. One doctor commented: " …the Interim Orders Panel hearing I went through was a kangaroo court beyond any doubt."

Around a quarter of the doctors reported changing their professional behaviour as a result of the complaint. Ten of these had considered a change in career, while seven had 'practised more defensively’, which included prescribing medicines as a precaution or avoiding difficult cases. One doctor stated ““I felt hurt and victimized, as a result I stopped being a full time GP principal and became a part time salaried GP”.

Just under a quarter of responses had positive feelings towards the process. Comments included: "I had full support of colleagues".

When asked how to improve the complaint system, many called for improvements in transparency, neutrality and time efficiency. Doctors also called for more open dialogue between doctors and patients, rather than information being passed between managers. One doctor commented that there should be “The opportunity to review the situation with parents/ patients in person through a ‘mediation’ type process.”

Nearly a third of the doctors also provided responses indicating they felt there was a “need for a policy for vexatious, baseless or unnecessary complaints’. One commented: “The person making a complaint must provide some evidence when such is applicable. Witnesses must be cross-examined.”

The team behind the study explained there is the potential for bias in the results, as only doctors with strong feelings about the complaints process would have answered the open-ended questions at the end of the survey. Furthermore those most affected by a complaint may have avoided engaging with the survey completely.

Professor Bourne adds: “Both this paper, and our previous quantitative paper from the same study show the complaints process is  associated with very significant effects on psychological health among doctors It also causes them to change their practice in ways that may impact on patient care, and incur unnecessary costs to health services.

"Doctors’ experiences and their perception of the most stressful aspects of complaints processes in the UK: an analysis of qualitative survey data" by Bourne et al is published in BMJ Open.