10/24/2015. Impact of complaints on doctor health and wellbeing. Outline. The GP. The GP. Avant. Avant. Regulator. Regulator

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1 Outline Impact of complaints on doctor health and wellbeing Georgie Haysom, Head of Advocacy at Dr Penny Browne, Senior Medical Officer at 25 October The medico-legal context 2. What does the research say? 3. What is s experience? 4. s current support for doctors 5. The future of doctors health support 2 Complaint > Failed to notify Drivers Licence Authority despite pleas by family subsequent accident son complaint No one knows this patient better > Response: Dr responded himself than me. I ve been treating her for 40 years. > Response: Dr responded himself. No response to lack of assessment/referral and poor records. > Notified of interview 40 years in same practice Own practice 2 part time GPs Wife practice manager/nurse Elderly patient population Bulk billing practice > Dr contacts 3 > Notification of interview > Ring > Dr is stressed Colleague support? Member support service? Drs Health Advisory Service? > Who knows > Can you send in all documents I don t want my wife and family to be stressed. > Please come in for a meeting so we can help you prepare I m very busy at the practice not sure if I can find the time. How long will this meeting be for anyway? > Dr contacts (2 days prior to interview) I ve put them somewhere not sure if I got them all my fax is not working at the moment. 4 1

2 Meeting with Medical Advisor / lawyer > Let him chat vent his feelings Once this is over I m going to sue for defamation. I ve never met the son how dare he especially as he never visits his Mum. > Competence > Future Yes I do mini mental testing but I didn t need to. Oh yes I will retire probably in the next 3-5 years. > It s a journey for the Doctor > Ask questions which interviewers will ask > Your practice > Health > The incident All my patients are as old as me. I don t need to do any assessment. I would know if the patient should stop driving as we chat all the time. I liaise with all my specialists, why do I need a GP? > Performance interview > Performance assessment notification > Risk management visit to the practice > Attend the interview > Follow up meeting at what happens next? Retirement 5 6 What can happen after an adverse event? The medico-legal context Adverse event Notification hospital, coroner Concern about individual External investigation eg. complaints body/ AHPRA Internal investigation Root cause analysis systems issues Disciplinary process Civil claim Coronial inquest Criminal prosecution 7 8 2

3 The effect of a complaint or claim on doctors What does the research say? Louise Nash one of the most stressful events a doctor will face Exposure to a complaint or negligence claim often involves a traumatic pattern of shock, initial panic, indignation, difficulties with work and home life and often anger or suicidal ideation. Studies One US study found 40% of doctors sued experienced depression and were more likely to develop new or an exacerbation of physical illness. Another study showed long term effects on doctor s sense of confidence and professional identity The effect of a complaint or claim on doctors UK study 2015 Bourne et alpublished a study of 8,000 doctors in the UK and found: What is s experience? Doctors who experienced professional complaints had a higher risk of anxiety and depression. Doctors were 3.78 times more likely to report suicidal thoughts while going through a recent or current complaint, compared with doctors who had no complaints. Changes in behaviour were identified even in those who only observed a colleague experience a complaint: 81.7% of doctors with no previous complaints reported hedging. 46.1% of doctors with no complaints reported avoidance behaviour

4 Our experience What our doctors say has assisted many doctors who have suffered adverse psychological reactions when involved in a medico-legal matter. successfully defended my claim. But this took far too long, causing continued personal and family stress, and disruption. Personally, I suffered great anxiety, self doubt and many other emotions To be honest I am still trying to come to terms with it all Reactions can include: Ambivalence, indifference Irritation, defensiveness, frustration, anger This has been the catalyst for my ceasing medical practice in Australia. I cannot deal with these events on top of the stress I am already under. There is no [other] job that puts practitioners under such stress and nobody gives a damn. Self-doubt, feelings of guilt and shame, embarrassment Sleeplessness, depression, anxiety, suicidal thoughts Suicidal ideation It is hard to understand the stress involved until you go through the process. I lost sleep for three months for what was always a spurious claim. I have seen first hand the real harm it causes to individual doctor s health, careers, partners, families, and patients Our experience Consequences What we have found What this means Thereis an impact on the doctor regardless of whether there is an adverse finding against them Doctors are the second victim The process of responding to a claim or complaint is stressful impacts on patient safety Lack of procedural fairness or natural justice in the process adds to the impact unintended resultthat the systemthat aims to protect the public has the opposite effect Delays,administrative errors and lack of transparency in the process adds to the impact There is an (often forgotten) impact on the families of practitioners

5 s support for doctors Day-to-day support for doctors Support for doctors with a complaint or claim Medico-legal Advisory Service (MLAS) Early contact with claims team Medical Advisor involved in most claims for: Familiarisationand to put doctors at ease Pastoral care Medical input into complaint or claim Risk management Member support offered early and reinforced at first meeting Support structures discussed early Time frame and steps to be undertaken addressed Doctors expectations and preferred outcome explored Regular update on progress Empowering doctors Accept unpredictability of legal process Exercise control where possible Time management Frequency of contact with legal team Consider the big picture Whatdoes this really mean Catastrophising Focus on healthy coping strategies Increase exercise Reduce other stressors Get support GP Member support program (psychologist) Family Good friends Occasionally a psychiatrist The future of doctors health support The future advocates that: Healthcare regulators, investigating authorities and other organisations should: acknowledge the impact on doctors minimise the risk of harm to doctorsby improving processes Future Input into regulatory and legal processes that impact on doctors and their wellbeing eg: working with AHPRA to consider doctor s perspective input into civil claims rules of the court to streamline processes should provide doctors with access to support and services Work with Doctors Health Advisory Service to develop processes for doctors requiring additional support Nationaladoption of the treating doctor exemption for mandatory reporting (WA exemption) Join our Community of Interest at on doctors health

6 s position on doctors health References > s Health and Wellbeing website > s position paper on the impact on doctors health on the Advocacy section of the website > Bourne T, Wynants L, Peters M et al The impact of complaints procedures on the welfare, health and clinical practice of 7962 doctors in the UK: a cross-sectional survey BMJ Open2015; 4:e doi: /bmjopen > Frank E, et al. The association between physicians and patients preventive health practices. Canadian Medical Association Journal 2013; 10:1503. > Frank E, et al. Mortality rates and causes among US physicians. American Journal of Preventive Medicine2000; 19(3): > Frank E, et al. Health practices of Canadian physicians. Canadian Family Physician 2009; 55(8): > Kay M et al. Doctors as patients: a systematic review of doctors health access and the barriers they experience. The British Journal of General Practice 2008; 58(552): > Nash L, et al. The psychological impact of complaints and negligence suites on doctors. Australasian Psychiatry 2004; 12(3): > National Mental Health Survey of Doctors and Medical Students, beyondblue, October > Royal Australasian College of Physicians. Health of Doctors Position Statement. RACP: Sydney, Important notices General disclaimer The information in this presentation is general information relating to legal and/or clinical issues within Australia (unless otherwise stated). It is not intended to be legal advice and should not be considered as a substitute for obtaining personal legal or other professional advice or proper clinical decision-making having regard to the particular circumstances of the situation. While we endeavour to ensure that documents are as current as possible at the time of preparation, we take no responsibility for matters arising from changed circumstances or information or material which may have become available subsequently. Mutual Group Limited and its subsidiaries will not be liable for any loss or damage, however caused (including through negligence), that may be directly or indirectly suffered by you or anyone else in connection with the use of information provided in this webinar 23 6