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Patient complaints focus on the same doctors

Half of all complaints are about 3% of doctors

Adrian O'Dowd

Thursday, 11 April 2013

Patients tend to complain about a small number of the same clinicians who could be spotted earlier as potential problem doctors, according to a study published online today in BMJ Quality & Safety.

Researchers found that half of all formal patient complaints made in Australia to health ombudsmen were to do with just 3% of the country’s doctors, with 1% accounting for a quarter of all complaints.

The researchers from the universities of Melbourne and Queensland analysed data from a national sample of 18,907 formal patient complaints filed against 11,148 doctors with health service ombudsmen (commissions) across Australia between 2000 and 2011.

They found that doctors complained about more than three times were highly likely to be the subject of a further complaint, often within a couple of years.

Almost two thirds (61%) of the complaints were about clinical aspects of care, while around a quarter (23%) concerned communication issues, including the doctor’s attitude and the quality or quantity of information provided.

Most (79%) of the doctors involved in complaints were men, and over half of all those complained about (54%) were aged between 36 and 55.

When the researchers analysed the complaints across all doctors in practice, this showed that 3% of practitioners accounted for 49% of all complaints made and 1% accounted for a quarter.

The researchers also looked at factors that might help to flag up those doctors at high risk of attracting further complaints.

They found that male gender, older age, and working in surgical specialties were all factors associated with a higher risk of repeat complaints, but the number of previous complaints was the strongest predictor.

Plastic surgeons had twice the risk of future complaints when compared with GPs.

Doctors named in a third complaint had a 38% chance of being named in another one within a year, while those with 10 complaints against them were almost certain to have another made against them within 12 months.

The authors concluded: “It is feasible to predict which doctors are at high risk of incurring more complaints in the near future. Widespread use of this approach to identify high-risk doctors and target quality improvement efforts coupled with effective interventions, could help reduce adverse events and patient dissatisfaction in health systems.”

In an accompanying editorial, Professor Ron Paterson of the Faculty of Law at the University of Auckland in New Zealand, said the problem was likely to be common in many countries.

Professor Paterson said: “What is surprising is the extent of the problem,” which he described as an “albatross around the neck of the Australian medico-legal system - and a problem likely to be replicated in other countries, even though the regulatory actors may differ.”

He argued that three or more complaints about a doctor should become a matter of public record, adding: “The current veil of secrecy over most complaints (which avoid publicity by never reaching the stage of disciplinary proceedings) allows repeat offenders to continue unheeded.”

Countries should follow the example of the UK doctors’ regulator the GMC and introduce formal appraisal of a doctor’s practice as part of revalidation, he added.

DOI:10.1136/bmjqs-2012-001691
DOI:10.1136/bmjqs-2013-001902

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