Physicians who are being investigated because of complaints tend to suffer from high rates of severe depression, anxiety and suicidal thoughts, according to a new U.K. study published in the journal BMJ Open. The researchers suggest that by causing psychological ill health and encouraging defensive practice, the processes designed to hold U.K. doctors accountable may actually pose negative consequences for patients. In a survey of 7,926 doctors, four out of five reported changing the way they treat their patients as a result of either complaints against themselves, or by observing a colleague go through the process. For example, many admitted practicing medicine more defensively as a result of being investigated or after witnessing the effects of investigations on a colleague.
Eighty-four percent reported hedging — overcautious practice such as overprescribing, referring too many patients, or ordering unnecessary tests. Forty-six percent reported avoidance (reluctance to take on difficult patients or procedures). The findings also showed that doctors who had recently been the subject of a complaint were twice as likely as other doctors to experience moderate or severe anxiety, and twice as likely to have self-harm thoughts. Study respondents who had been referred to the General Medical Council (GMC), the organization by which all practicing doctors in the U.K. must be registered, had especially high rates of psychological illness, with 26 percent reporting moderate to severe depression and 22 percent moderate to severe anxiety.
“Of course it’s essential that when things go wrong, the reasons are properly investigated. But this study suggests that the regulatory system we have in the U.K. has unintended consequences that are not just seriously damaging for doctors, but are also likely to lead to bad outcomes for patients. “We think this needs to be looked at carefully by policymakers,” said lead author Dr. Tom Bourne from the Department of Surgery and Cancer at Imperial College London. “Our data suggests the impact of complaints procedures of all kinds on doctors is often disproportionate to the issue being investigated,” said Bourne. “For example the vast majority of doctors referred to the GMC are found to have no case to answer, yet many doctors being investigated show high levels of serious psychological morbidity and we know this impacts on how they treat patients.”
The study also found that 20 percent of doctors felt the complaint against them was a result of them being victimized after whistleblowing; 39 percent said they felt bullied when going through the complaints process; and 27 percent had more than a month off work as a direct result of the complaints process. “A key issue that has come out of the study is the apparent impact on patient care of these complaints processes,” said Bourne. “We need a new structure that is transparent, fair, and has the confidence of all parties.”
This article first appeared in Psych Central, 18 January 2015.