Survey suggests four-fifths of medics who have been subject of complaint or litigation start practising more ‘defensive medicine’ The research said while scrutiny is there to protect patient care, it is ‘clearly having unintended consequences’. Patients are being put at risk because doctors are giving them drugs they do not need and sending them for unnecessary surgery to avoid a complaint being made against them, research has revealed. Medics are so scared of being complained about that they are also giving patients more tests than their symptoms merit and not performing procedures that involve more risk than usual. Four out of five doctors who become the subject of a complaint find the experience so stressful that they start practising more “defensive medicine” than before, according to a survey of 6,144 doctors in Britain about whom a patient, relative or colleague had complained. “This involved ‘hedging’, which includes performing more tests than necessary, over-referral and overprescribing as well as ‘avoidance’, which includes avoiding procedures, not accepting high-risk patients or abandoning procedures early,” according to research by a team led by Prof Tom Bourne of Imperial College London, whose findings have been published in the journal BMJ Open. “These behaviours may have a serious impact on patient care,” they warned. While litigation, complaints and investigations are intended to protect patients from poor care and medical negligence, the “burden and stress associated with these processes are clearly having unintended consequences and it may be argued that when examined as a whole, these structures may be causing more harm to patient care than good,” the study said. “While the regulatory system may protect patients from the misconduct of a relatively small number of doctors, it has a perverse effect on the majority of doctors who become preoccupied by defensive practice,” it added. Doctors who resort to “fear-driven working practices that could compromise patient care” also waste vital resources and their conduct “creates significant costs for the NHS”, the co-authors added. Bourne could not quantify how much NHS spending goes on that, but pointed to a study that found such practices accounted for 10% of Italy’s health budget. The General Medical Council, which regulates Britain’s 250,000 doctors, receives 9,000-10,000 complaints a year. About 160 doctors a year are suspended or banned from practising altogether after a complaint to the GMC. However, medics can also have their conduct investigated after a complaint to the hospital trust, health board or GP surgery that employs them. Some are investigated by several different bodies. Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said that while regulation of the medical profession is vital to maintain patient safety, most complaints to the GMC are not upheld. “If we’re at a stage, as this research indicates, where some doctors are making decisions based on fear of recrimination and not what is necessarily in the best interests of the health of the patient in front of them, it is not conducive to high-quality, patient-centred care – and something in the system is not working properly,” she added. Being complained about is often bad for doctors’ mental health, with many experiencing depression, anxiety or stress because of a process that many believe takes too long and is unfair on them, the authors found. Many also have trouble sleeping and become angry and irritable. The report’s authors recommend sweeping changes to the existing complaints system, including that doctors should be able to contact colleagues while they are suspended, that suspension should only be used as a last resort and that investigations should have to stick to tight deadlines. The GMC said it had recently improved how its system of investigating complaints against doctors works. “We are carrying out fewer full investigations than ever before, thanks in part to the use of provisional inquiries to improve the information we have available when deciding if a full investigation is necessary,” a spokesman for the council said. “We now have a dedicated health team and have made other changes to support vulnerable doctors. “We continue to be concerned about the health and welfare of all doctors, but particularly doctors in training. This matters because of the impact on doctors themselves, the potential impact on patients and the risk that, unaddressed, good doctors can end up leaving the profession altogether.” Source
