Complaints don’t have to be a stress-filled nightmare, says Professor Marie Bismark – sometimes they’re a learning opportunity.
Resolving a patient complaint can often be straightforward and GPs shouldn’t become defensive when a complaint is made against them, says one of Australia’s top medico-legal experts.
Professor Marie Bismark recently shared some of her research papers on Twitter, outlining what she has learned in 20 years of studying patient complaints.
Based on her studies, Professor Bismark said much of complaint resolution is “just what we teach our children”.
“If you hurt someone or upset someone, you should say sorry, you should be honest about what you’ve done, you should try and fix the problem, and you should try not to do it again,” she said.
“Medicine makes us feel defensive about complaints whereas they can actually be an incredible opportunity to learn from the patient’s experience to improve the way we deliver care.”
Professor Bismark – she’s a professor of public health law at Melbourne University’s School of Population and Global Health – has published widely on no-fault compensation, patient safety and healthcare complaints resolution.
Her conclusions come at a time when dissatisfaction with the way regulators handle patient complaints is growing. Healthcare peak bodies are particularly concerned that an amendment to the National Law, due to be considered by the Queensland Parliament very soon, would allow AHPRA to issue a statement about a health practitioner under investigation before the investigation is complete.
Surgeons and psychiatrists have a higher rate of notifications than other specialists, such as GPs, according to Professor Bismark.
“There’s a pretty direct connection between having a procedure and knowing whether it was a good or a bad outcome – particularly cosmetic procedures,” she said.
In several of her studies, Professor Bismark found a majority of complaints stemmed from a small number of doctors, with 3% of doctors accounting for 49% of patient complaints in Australia. In the US, just 1% of doctors accounted for a third of all paid medical malpractice claims.
“Some [clinicians] just have a very abrasive communication style – which they can learn to change – and some of them are doing high-risk procedures, so perhaps they need to adjust their scope of practice so they’re not doing those procedures. It’s really important with a high-risk group to identify the ones who can be supported back into safer practice, and then to identify the ones who really shouldn’t be working in medicine any more.”
The distribution of complaints among doctors is highly skewed: in Australia 3% of doctors account for 49% of complaints. Efforts to identify high-risk doctors coupled with effective interventions, could help reduce adverse events & patient dissatisfaction. https://t.co/ZSztt5c6eS
— Prof Marie Bismark (@mbismark) September 9, 2022
Professor Bismark is not as concerned about AHPRA’s operations as some peak bodies and individual practitioners who have spoken out against the regulator.
“I think there’s still a lot of misunderstanding and misinformation about AHPRA,” she said. “With areas like mandatory reporting, some doctors fear they can’t talk to their GP about their depression because they’ll be reported, whereas that’s just not the case at all.
“There’s actually a very high threshold [before a doctor is reported] – there has to be a serious risk of patient harm. So I think there’s quite a lot of misunderstanding about the regulator’s role, and I do think they’re continuing to try to improve.
She said AHPRA was also limited in what it could say in public. “You sometimes have these situations where there’ll be really strong criticism on social media of an AHPRA decision without people necessarily being able to see everything that went on behind the scenes.”
The AMA might see it differently.
At the association’s annual meeting in late July, AMA Victoria called – unsuccessfully – for a Royal Commission into AHPRA. Among other things, the group’s motion demanded the objectives of the National Law’s registration scheme be amended “to mandate that AHPRA has a duty of care to the Registrant and in particular to minimise the mental health impacts and financial effects on the health practitioner under investigation”.
But according to Professor Bismark, understanding a patient complaint may ensure it’s cleared up before the issue gets anywhere near AHPRA.
“Mostly, when a patient makes a complaint it’s either because they really want to understand what went wrong and to have someone explain what happened, or it’s because they want to make things better for other patients and don’t want anyone else to suffer the harm they went through,” she said.
“When patients don’t feel they’ve been heard, they don’t feel their experience has been taken seriously, or they don’t feel like any changes are being made. That’s when they begin to think about talking to a lawyer, going to the Medical Board or seeking some kind of sanction against the doctor.”
