Patient characteristics of, and remedial interventions for, complaints and medico-legal claims against doctors: a rapid review of the literature

BACKGROUND

It is uncertain if patient's characteristics are associated with complaints and claims against doctors. Additionally, evidence for the effectiveness of remedial interventions on rates of complaints and claims against doctors has not been synthesised.

METHODS

We conducted a rapid review of recent literature to answer: Question 1 "What are the common characteristics and circumstances of patients who are most likely to complain or bring a claim about the care they have received from a doctor?" and Question 2 "What initiatives or interventions have been shown to be effective at reducing complaints and claims about the care patients have received from a doctor?". We used a systematic search (most recently in July 2023) of PubMed, Scopus, Web of Science and grey literature. Studies were screened against inclusion criteria and critically appraised in duplicate using standard tools. Results were summarised using narrative synthesis.

RESULTS

From 8079 search results, we reviewed the full text of 250 studies. We included 25 studies: seven for Question 1 (6 comparative studies with controls and one systematic review) and 18 studies for Question 2 (14 uncontrolled pre-post studies, 2 comparative studies with controls and 2 systematic reviews). Most studies were set in hospitals across a mix of medical specialties. Other than for patients with mental health conditions (two studies), no other patient characteristics demonstrated either a strong or consistent effect on the rate of complaints or claims against their treating doctors. Risk management programs (6 studies), and communication and resolution programs (5 studies) were the most studied of 6 intervention types. Evidence for reducing complaints and medico-legal claims, costs or premiums and more timely management was apparent for both types of programs. Only 1 to 3 studies were included for peer programs, medical remediation, shared decision-making, simulation training and continuing professional development, with few generalisable results.

CONCLUSION

Few patient characteristics can be reliably related to the likelihood of medico-legal complaints or claims. There is some evidence that interventions can reduce the number and costs of claims, the number of complaints, and the timeliness of claims. However, across both questions, the strength of the evidence is very weak and is based on only a few studies or study designs that are highly prone to bias.

Managing patient complaints to improve your practice

BACKGROUND

Increasing numbers of patient complaints to regulators suggest practices need effective systems to manage and address patient concerns. Many patient complaints can often be dealt with at a practice level, but patients can have difficulty reporting negative experiences directly.

OBJECTIVE

This article explores the benefits of having a system to accept and deal with patient feedback within a practice and identifies barriers preventing patients from raising their concerns directly.

DISCUSSION

Managing patient complaints well at a practice level can prevent them escalating, as well as offering insights to reduce risk and improve patient care. Understanding factors that inhibit patients from raising concerns, or prevent staff from being able to accept and deal with complaints, allows an opportunity for practices to implement strategies to address these barriers and support patients and staff. Effective strategies include process improvements, as well as cultural changes and support for those managing a complaint process.

Supportive networks, healthier doctors and 'just culture': Managing the effects of medico-legal complaints on doctors

BACKGROUND

When an error leads to possible patient harm and a complaint, the impact on doctors and patients can be profound. Doctors may respond in ways that risk harm to themselves, colleagues and patients, including withdrawing from peers, risk-avoidance practice and even suicidal ideation.

OBJECTIVE

This article discusses current research and public discourse on the impact of complaints on doctors' personal and professional lives, as well as the way complaints and the fear of complaints affects doctors' clinical practice. It suggests strategies to ameliorate these effects before a complaint is made.

DISCUSSION

When colleagues support one another and collectively reflect on their practice within a culture focused on patient safety, doctors facing complaints or presented with an error are less likely to isolate themselves and fear the worst. Using a common adverse event, the author discusses how analysing minor errors and near-misses can benefit patients, practitioners and practices.

The impact of complaints on doctors

BACKGROUND

There has been increased recognition in the literature of the impact that complaints can have on practitioners' health and wellbeing.

OBJECTIVE

This article reviews the recent literature about the impact of complaints on practitioners and explores the experience of a medical defence organisation (MDO) assisting its members with those complaints. The article also considers proposals to improve the complaints system in order to reduce the adverse health impacts that doctors may face after receiving a complaint.

DISCUSSION

Australian regulators should formally acknowledge the significant impact the complaints process can have on practitioners, and continue to improve the process to reduce these adverse effects. MDOs have a role in supporting their members, and in educating them about the process and how to minimise the impact. Doctors' health advisory services have a key role in providing sup-port to practitioners in need. Members of the profession should encourage a culture that is supportive of the health and wellbeing of colleagues.

Mandatory reporting of health professionals: the case for a Western Australian style exemption for all Australian practitioners

This article discusses the current mandatory reporting obligations for health practitioners in Australia under the Health Practitioner Regulation National Law. It provides a summary of the mandatory notification legislation, and contextualises the introduction of this law. The details of the Western Australian exemption, under which a treating doctor is exempt from mandatory reporting of a doctor-patient, and the rationale for its introduction are examined. This is followed by a consideration of the potential impact of the mandatory reporting obligations. The authors argue that the Western Australian exemption has merit and should be considered for adoption throughout Australia.