Complaints handling processes risk doctors' health

POOR processes and prolonged timescales in the investigation of GMC and other complaints against doctors are associated with decreased psychological welfare and increased defensive practice, according to a study published in BMJ Open.

In the study led by researchers from Imperial College London, over 6,000 doctors with past or current patient complaints against them completed an anonymous online survey to measure their perceptions of the complaints procedure. The survey also assessed anxiety and depression along with a new measure for defensive practice.

It found that most respondents felt supported by colleagues (61 per cent) but only 31 per cent felt supported by management.

Doctors who reported feeling supported by colleagues were 36 per cent less likely to experience depression, and 31 per cent less likely to experience anxiety. They were also less likely to practice defensively. Doctors who reported feeling supported by management were 13 per cent less likely to experience depression and 20 per cent less likely to experience anxiety. They were also less likely to practice defensively, and nine per cent less likely to practice avoidance.

The study uncovered significant overall dissatisfaction with how complaints were handled with respondents identifying poor process (56 per cent), protracted timescales (78 per cent), vexatious complaints (49 per cent), feeling bullied (39 per cent) or victimised for whistleblowing (20 per cent) and using complaints to undermine (31 per cent). These were associated with decreased psychological welfare and increased defensive practice.

Doctors worried most about professional humiliation following a complaint investigation (80 per cent).

Professor Tom Bourne, lead-author from Imperial’s Department of Surgery and Cancer, said: "Patient complaints are important and should be used to improve the care doctors provide. However, the processes used to investigate them should be consistent with the principles of natural justice.

"The current culture of fear causes physicians to practice defensively, which is clearly not in the interest of patients and creates significant costs for the NHS. We must develop a system that’s fair and timely."

Professor Bourne added: "Authorities can help reduce the impact of these procedures on doctors’ wellbeing by imposing time limits on investigations, and making them more transparent and less adversarial. This will benefit patients by reducing defensive medical practice."