Painful procedures

We all know the feeling of being in a long traffic jam, suddenly stuck behind a big truck, unable to see anything and not knowing what has happened to cause the delay.

Then you turn on the radio and learn there has been an accident, that emergency services are in attendance and that there will be a two-hour delay before traffic can move again.

The situation is annoying but easier to cope with when you know what’s going on. So, you get on with doing something while you wait.

This is the situation that faces many doctors undergoing an Ahpra investigation. The lack of information about the progress of their complaints and what will happen next is frustrating and distressing. Doctors want to know the next steps and how long they will take, and they want the matter resolved so they can get move on.

This process can take many months and the impact on the health and wellbeing of doctors is unpredictable. Whether the complaint is minor or major, the doctor’s response may be the same. It may range from mild to severe, but it is universally distressing and may precipitate a strong sense of unfairness, guilt, embarrassment, anger, depressed mood, despair, and even thoughts and plans of suicide.

Complaints can alter the way doctors practise following the notification. They may avoid certain patient problems and types, practise more defensively, become less engaged with professional life, avoid colleagues and clinical meetings, over- investigate, work shorter hours, refer patients more often and become more suspicious of their patients. Personal and marital relationships may suffer.

Some complaints are known to be vexatious, frivolous or mischievous. The Medical Board and Ahpra have recognised this and over the past two years introduced a panel of assessors who look for these and filter them to avoid them being processed in the standard way. This has reduced the waiting times for complaints to be fully resolved from about eight to about three months. For most doctors, this is still a purgatorial wait.

A study from the UK’s General Medical Council several years ago highlighted the number of doctors who had suicided while undergoing or in response to a complaint. A similar study in Australia has identified 16 doctors in the past four years who have suicided while undergoing the complaints process. While the link has not been proven in all cases, the GMC experience and the experience of the treating doctors working in the doctors’ health programs around Australia suggests the link very strongly.

Doctors can misunderstand the triggers for notification and the complaints process and what will happen. The medical defence lawyer has a critical role here to explain this, but a doctor who is notified of a complaint can also benefit from the advice of a senior medical college who can put the complaint into clinical perspective. Catastrophic thinking is often out of proportion to the nature of the complaint. Timely advice is critical for perspective –and can be life-saving.

A complaint may arise in the setting of a doctor carrying an excessive burden, the extent of which is so great that the complaint is the straw that just cannot be borne. A doctor’s burden can compound and be acute and long-standing. Contributing factors may be directly related to work, such as a patient death, excessive workload, business duress, financial debt, or overcommitment to college roles; or indirectly related, such as marital and relationship duress.

The lonely, overworked doctor who is depressed may start to take risks (a recognised symptom of depression in men) and cross boundaries or upset patients with their lack of empathy.

Ahpra is looking closely at this issue. It has established an internal team to examine the complaints experience and the impact of notifications.

The value of a comprehensive medical check-up by an independent treating GP for a doctor undergoing the complaint process has also been discussed. This recognises that a doctor undergoing a complaint may have undiagnosed physical and mental health problems that have contributed to the situation. It is also an opportunity to improve the health of the doctor over the longer-term.

The process of complaint resolution is stressful but the outcome should not be catastrophic for the doctor or their family. The regulator, insurers and the profession must take all possible steps to make the process is efficient, fair, transparent, humane and supportive, for the benefit of all involved.