My New Business Venture — Outsourcing the Patient Complaints Process for Doctors.
The last thing doctors need right now is another reason to experience workplace stress. Tired, run down, sleep and holiday deprived and continuing to work in PPE and via Telehealth is definitely taking its toll. Yet there is another reason, borne directly from the stressors impacting our everyday life. Patient complaints seem to be on the rise, and the delivery of the message, as well as the protracted time it is taking the regulators to investigate isn’t helping either.
A lot of my clinical work in doctor’s mental health rose from the emotional stress and hardship a doctors faces when they are notified about a complaint. Universally, complaints hurt most when arise out of nowhere, seemingly from patients that doctors feel they went ‘over and above for’, and were unaware the patient was unhappy. The majority of doctors I cared for clinically could not identify the actual harm that formed the basis of the complaint. In many cases, the patient was spiteful, drew on personal attacks and in some cases presented a very different view to the doctor’s recollection.
We all know that there is a small but tragic outcome from patient complaints, that of doctor suicide. Hence, my mantra when working in this space was that I cared very deeply about patient safety but not at the expense of doctor safety. The way regulators notify doctors about complaints, still via email with no check in prior, has been brought into question many times by many advocates. Yet calls for a more humane approach to the complaints process seems to have fallen on deaf ears.
With the rise in patient demand for medical services during the COVID-19 pandemic, and now to address the backlog created by bans on elective surgery, complaints have risen as a consequence. Articles are appearing about the concerns many doctors are voicing that they have been asked to work in unsafe ways for far too long, with the concern about patient outcomes. However, in our system that has buckled under the pressure of catastrophic demand, one thing is for sure. Hospitals will lay blame and admonish responsibility when complaints are investigated.
When blind sighted by a notification from a regulatory body such as AHPRA or the HCCC, doctors generally know to call their medical defense organisation (MDO). Advisors man the phones around the clock and also report being swamped by the rise in calls. They seem more educated in their approach with regards checking on the doctor’s safety and informing the doctor about emergency support services. Their brief is to obtain an account of the circumstances from the doctor and to assist with the reply to the regulator. They also provide basic legal advice and offer a strategy to defend the claim.
But at the end of the day, our MDO’s are insurance companies, and despite their best intent to defend their clients, like lawyers, they push for settlement of a grievance to the best of their professional duty. Sometimes it doesn’t come down to ‘who is right and who is wrong’. This is further complicated by the fact that doctors faced with the news of a complaint and reeling from the shock often deny, deflect and avoid the situation for as long as they can. Doctors quickly resort to feelings of shame and humiliation, which is often inappropriately attributed. They can close down, withdraw from colleagues and hope that nobody finds out.
It is difficult not to feel a complaint is personal when it contains a personal attack and an attack on personal acts or intentions. But the very opposite is true. Human interactions are complicated, humans often try and blame others when things go wrong and humans get angry when somebody they love gets hurt. In addition, our complaints processes are anything but personal. The same online form is used by any aggrieved person, uploaded to the same site, to be funnelled through the same preliminary channels, and ultimately generate to the same worded email. Regulators operate with bureaucrats driving the process. But for the doctor at the other end, the whole process can feel very nasty and very vindictive.
With the increase in complaints, the time to notification and then resolution can take months, even for those complaints found to have no basis. It’s almost cruel that just as the doctor forgets about the matter, an email lands or a phone call arrives out of the blue, just to jog them back, and raise their heart rate. Overall in the process doctors are very reactive, when being proactive could facilitate earlier resolution and relief.
With all of these points pertinent to the idea of this new business venture, the real flashbulb moment for me came when I received a notification from AHPRA. It was made by a patient I looked after on a recent locum post in regional Victoria in January 2022. I knew it was coming because the patient threatened me that if I didn’t meet her needs she would report me. She had become increasingly fixated on me, pressuring staff to make her an appointment to see me then not attending at the scheduled time. Management were aware of the situation, that had also been reported by other staff members falling victim to the same behaviour. Nonetheless, this patient did have the right to make a complaint if they felt aggrieved. AHPRA have handed the matter to the HCCC as did not feel their were grounds to pursue. During this process I have developed anger that I simply don’t have the time or energy to defend this one. I found myself asking, If only there was somebody who could do this for me? And hence the idea was born.
My aim is to provide the same level of quality care to doctors that I strived for as a benchmark in my doctor’s clinic. This time it will not be in a clinical capacity, but as somebody with the expertise of the complaints process, how doctors react to complaints and how to resolve the matter as efficiently as possible. It should go to the heart of reducing doctor distress. And that to me is always the most important factor of all.
Dr Helen Schultz is a consultant psychiatrist, freelance writer and long term advocate for doctor mental health. You can read more about her at www.drhelenschultz.com.
Contact details — firstname.lastname@example.org, Twitter @DrHelenSchultz.