I suspect that, deep down, the vast majority of us enjoy being doctors, as the job has plenty of positives. As in any job, though, there are plenty of negatives too, and one area of significant concern for doctors is the complaints process. Complaints are meant to be a source of redress for patients and learning points for doctors, but it can be a stressful time for all involved.
All of us care about our jobs and the work we do, and we take great professional pride in the service we provide to our patients. Even with the best will in the world, however, things can go wrong. As we have high visibility and a large degree of personal responsibility, we can naturally become the focus of a complaint. Of course, there may be a good basis for a complaint (or litigation, for that matter) around care, a communication issue, or a misunderstanding that has led to the grievance. Equally, patients or their representatives must have the right not only to make a complaint but to make sure that it is dealt with fairly and quickly. And any lessons learnt should be made widely available, not just to the individuals involved.
Even so, for a conscientious doctor (and I like to think that we are all conscientious), the complaints or litigation process can be an unpleasant and stressful experience. This was highlighted in a recent Univadis Medical News article (http://www.univadis.co.uk/medical-news/287/Complaints-increase-doctors-depression) that started by saying, “Doctors with a current or recent complaint against them are more likely to report severe depression or anxiety and to harbour suicidal thoughts than those with no complaints, a study has shown.”
The study, published in BMJ Open, also found that the complaints process encouraged a more defensive practice of medicine—something I guess we can all sympathise with, especially if we have been at the receiving end of a complaint. Not surprisingly, doctors who were reported to the professional regulator had the highest incidence of mental health problems. Worryingly, the article also said that a “report by the GMC in December found that 28 doctors had died by suicide or by suspected suicide while under fitness to practise investigations, and it called for a national support service for doctors.”
We do need a robust, fair, and respected complaints process that can help to highlight areas where we can improve our practice; but a doctor at the receiving end must also have full support. Of course, the medical defence unions can be supportive, and the BMA has a counselling service—but I think that more is needed.
Patient safety must remain the number one priority; but, as the authors of the study pointed out, “A system that is associated with high levels of psychological morbidity among those going through it is not appropriate. Most importantly, a system that leads to so many doctors practising defensive medicine is not good for patients.”
Sadly, I have a funny feeling that this big and important issue will not be dealt with for some time, simply because it is not high on the list of current healthcare priorities.
By Dr Harry Brown, editor-in-chief, Univadis