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Formal complaints against doctors are relatively common and most are eventually dismissed, but the emotional scars they leave behind often cut deep.
On Thursday, Australian Doctor published the personal story of a Melbourne doctor during a three-month AHPRA investigation.
In the second part of this special report we look at the ways doctors survive complaints (see below) and meet a former investigator who is calling for reform of a system she says is causing much harm.
Each year, about 5000 doctors will sit at their desk, go through their emails and open one that will turn their world upside down.
These emails from AHPRA will advise that they are the subject of a formal complaint. Usually, this is the first time they are made aware of the accusations.
It is unquestionably one of the most feared and isolating experiences of medical practice.
As one doctor described it: “The potential consequences in terms of income, livelihood, quality of life, standard of living — you just see that vanishing out the window, instantly.”
What are we doing to doctors?
Elizabeth Ekert (pictured) has watched doctors suffer the fear, the anger and the dread. After spending eight years as a senior investigator with the NSW Health Care Complaints Commission (HCCC), she has seen “the best and the worst”.
She’s been there as doctors have successfully emerged on the other side of the complaints system and still walked away from medicine. But one young doctor stands out in her memory because his story illustrates just how hostile the process can be.
“It’s what led me to where I am now. In those days, if you investigated a complaint and it had legs, or there were significant criticisms, there was a hearing and you had to prosecute,” Ms Ekert says.
The young doctor facing the hearing was working in a rural area when he prescribed steroids that were medically unnecessary.
“I asked him in the hearing: ‘I don’t understand it; what was it about this patient?’
“It turned out some terrible things had happened in [the doctor’s] life, he was suffering from depression at that time and there were so many tears, and I remember thinking, ‘What are we doing to him?’
“I asked for an adjournment and said to the legal officer: ‘He can have a reprimand, fine, but he needs help; he’s completely isolated professionally’ and they agreed.”
Ms Ekert says a member of the medical board agreed to mentor him and introduced him to colleagues at the local hospital’s lunchtime seminars.
Six months later, he was a different person.
An overwhelming sense of threat
“That [case] really struck me, that this could have been resolved in a different way,” she says.
“He wasn’t a bad person, yet he’d be one of these people who’d be on the record forever, and he’s not a bad doctor — he was a fabulous doctor, a wonderful doctor, and here we are prosecuting him, using these harsh legalistic words.”
She later left the HCCC and spent 11 years working as medicolegal risk adviser for Avant and MDA National.
But she wanted to get a better understanding of why the results of complaints in medicine had the power to inflict so much damage — more so, it seemed, than many other professions.
“I enjoyed the investigations work very much at HCCC, in particular finding out what happened and why, and providing answers for people who had complained. But I was bothered by the process itself,” she says.
Now a PhD student, she has decided to interview 17 Australian doctors who have been caught up in litigation or the wider complaints process.
What stands out is simply the “overwhelming sense of threat” that goes to the core of their self-image of what being a ‘good’ doctor is about.
“Many of them said to me: ‘I don’t want to be seen like that [a bad doctor], and I feel as if I’m being treated that way, and I’ve got to prove myself as not one; the system says I have a case to answer’,” she says.
“They think: ‘I might be guilty’ and therefore they feel guilty. What surprised some participants during the interviews was that the raw emotion they thought had long ago passed was still there, deep inside,” she says.
Common themes of fear and loss emerged among the doctors she spoke to, but the big one was stigma and the fear of being ostracised.
Very few confided in their colleagues, and few opted to tell anyone else beyond their partners.
One doctor told her: “I was quite terrified, because even though you’re a rational being, seeing something highly personalised like this, you have immediate images of losing your livelihood, losing your reputation.
“What are colleagues going to think of you? Are you going to lose your private practice because the outcome of the complaints process will be published?”
Another said: “No one contacted me to see how I was, and I was devastated that people that I thought would offer some form of support were very keen to just wash their hands and walk out and not associate themselves.”
Ms Ekert says she hears more doctors speak positively about surviving the complaint when they say they feel supported.
“When a doctor’s sense of worth is threatened, what helps to mitigate the shock and shame is the collegiality of those around them — affirming that they’re okay, that they are worthy of their care and support, and knowing that it is normal to feel unnerved.”
She recalls speaking to one surgeon who was being sued and had a complaint made after things went awry during an operation.
“But his colleagues were there and respected him. They said, ‘It’s okay, we know what you did, and it’s fine’ and they stuck by him and this guy survived,” she says.
“Mind you, he didn’t survive the complaints process very well. In fact, he told me he wanted to give up medicine.”
After-effects echo
What the surgeon’s story highlights is the brutality of coping with the investigation process, Ms Ekert says.
“Often, what made [the doctors] feel so uneasy was not just having a complaint against them, but that nobody could tell them what the options are for afterwards.
“They’ll go to their medicolegal adviser and legal defence organisation and they don’t know either. Now you can get a feel for things, whether something is likely to a be a shocker or not. But you don’t know how it’s going to be interpreted; you really don’t. It’s an unknown,” she says.
“[The doctor] won’t know who’s going to be looking at it and on what basis they’re going to be evaluating it, and they don’t know really what the process is, step-by-step. Even if they did, would it make any difference?”
It takes a heavy toll on the doctors’ mental and physical health. One of the largest surveys of Australian doctors found that of those with a current medicolegal matter, nearly half (44%) became depressed.1
Ms Ekert says many of the doctors were scarred by the complaint and came to see it as a significant turning point in their career or the biggest crisis of their life.
The complaints process needs to “take better care” of these doctors, she said, and ensure it doesn’t diminish otherwise good doctors any further.
But given the frequency of complaints — from the unsubstantiated and relatively trivial to those that can end a doctor’s career — she says “normalising” the medicolegal process is also critical.
“I’ve always felt it is important that this is part of a doctor’s professional training. That they are made aware there is a medicolegal world out there and its demands are no different from doing your tax.
“Hopefully they can be reassured that sometimes they are going to have to write a letter to the coroner or a report — and that is normal.”
This, as well as supporting colleagues going through the nightmare, could help change the culture of secrecy surrounding complaints and help more doctors emerge less traumatised and isolated by the experience.
| What works – surviving complaints |
| “We know it’s one of the most stressful things they ever go through career-wise, but we know most of them do come out okay,” Dr Penny Browne says.
Dr Browne, chief medical officer with Avant, has been there as peer support for doctors when they feel the walls closing after a complaint has been made and when the investigations begin. What worries her are those doctors who isolate themselves, who keep it all wrapped up in an attempt to protect themselves. “It always frightens me when a doctor won’t even tell their partner. They’re more likely to be bottling things up then. If they’re on their own, they’re likely to catastrophise it,” Dr Browne says. Talking to peers about the case can be therapeutic, but Avant also offers a free counselling service for doctors in distress, she says. “We also try to provide doctors with as much information as we can of what’s coming, the process itself. “Doctors are knowledge-hounds. They don’t like uncertainty, and they feel in control if they feel they have as much knowledge as they can.” From her experience, doctors who have support behind them and employ self-care at times of peak stress are in a better position to come through the ordeal without deep scars. “I spoke to a doctor who had a long matter that went right through to trial, and I asked him how he coped. He said: ‘I had to use every tool in my toolkit: regular exercise, a good amount of sleep, make sure I had a break away from it from time-to-time, make sure the alcohol didn’t creep up and, at times, I even had to do things like meditation.’ “And even then he said it was the most stressful thing he’s been through.” If this news story has raised issues for you, or you’re concerned about someone you know, call Lifeline on 13 11 14. You can also contact your local Doctors’ Health Advisory Service. |