The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross-sectional survey

Abstract

ObjectivesThe primary aim was to investigate the impact of complaints on doctors’ psychological welfare and health. The secondary aim was to assess whether doctors report exposure to a complaints process is associated with defensive medical practise.DesignThis was a cross-sectional anonymous survey study. Participants were stratified into recent/current, past, no complaints. Each group completed tailored versions of the survey.Participants95 636 doctors were invited to participate. A total of 10 930(11.4%) responded, 7926 (8.3%) completed the full survey and were included in the complete analysis.Main outcome measuresAnxiety and depression were assessed using the standardised Generalised Anxiety Disorder scale and Physical Health Questionnaire. Defensive practise was evaluated using a new measure. Single-item questions measured stress-related illnesses, complaints-related experience, attitudes towards complaints and views on improving complaints processes.Results16.9% of doctors with current/recent complaints reported moderate/severe depression (relative risk (RR) 1.77 (95% CI 1.48 to 2.13) compared to doctors with no complaints (9.5%)). Fifteen per cent reported moderate/severe anxiety (RR=2.08 (95% CI 1.61 to 2.68) compared to doctors with no complaints (7.3%)). Distress increased with complaint severity, with highest levels after General Medical Council (GMC) referral (26.3% depression, 22.3% anxiety). Doctors with current/recent complaints were 2.08 (95% CI 1.61 to 2.68) times more likely to report thoughts of self-harm or suicidal ideation. Most doctors reported defensive practise: 82–89% hedging and 46–50% avoidance. Twenty per cent felt victimised after whistleblowing, 38% felt bullied, 27% spent over 1 month off work. Over 80% felt processes would improve with transparency, managerial competence, capacity to claim lost earnings and action against vexatious complainants.ConclusionsDoctors with recent/current complaints have significant risks of moderate/severe depression, anxiety and suicidal ideation. Morbidity was greatest in cases involving the GMC. Most doctors reported practising defensively, including avoidance of procedures and high-risk patients. Many felt victimised as whistleblowers or reported bullying. Suggestions to improve complaints processes included transparency and managerial competence.

National Survey of UK Consultant Surgeons’ Opinions on Surgeon-Specific Mortality Data in Cardiothoracic Surgery

“…A recent cross-sectional survey of over 10 000 physicians in the United Kingdom suggested that those who had undergone investigation were at higher risk of suicidal ideation and 77% more likely to be depressed. 24 It is thus not unfeasible that surgeons may demonstrate abnormal behaviors in stressful environments as a method of coping. Although there is regional variation, the current process for data entry in the United Kingdom involves submission of case data by an individual surgeon (or his/her junior) to an institutional database.…”

The ‘good’ professional regulator

“…4 One speaker referred to doctors' increased vulnerability to self-harm and mental distress following complaints. The discussion focused on the potential of regulators to be viewed as adversaries rather than as humane and objective investigators charged with public protection and fairness in relation to professionals.…”

Doctor in the sky: Medico-legal issues during in-flight emergencies

“…239 Doctors receiving complaints have increased risk of developing anxiety and depression. 240 More worryingly, even in the absence of any regulatory investigation, 10% -20% of doctors suffer from depression at some point in their careers. 241 In general, any legal proceedings filed against doctors, particularly criminal prosecutions, if brought to the attention of GMC, are apt to lead to investigations on doctors' fitness to practice (FTP).…”