Being subject to a complaint or claim is an ever-present risk of clinical practice. Cognitive Institute faculty member Dr Bronwyn Hartwig discusses the importance of looking after your own wellbeing at this stressful time.
Working with clinicians taking part in our clinical communication and one-one-one programmes, I see first-hand the impact a serious complaint or claim can have on personal and professional lives. As doctors, we know that while many of us will practice without ever being the subject of a complaint or claim, it remains an ever-present risk of our work. If you have been or are ever subjected to the process of complaint or claim, it is important to take proactive steps to manage your own health and wellbeing, regardless of the circumstances that led to that complaint or claim being made.
A dangerous time
It goes without saying that clinical work is demanding and stressful. In a 2013 report Australian organisation Beyondblue found that doctors reported significantly higher rates of psychological distress, suicidal thoughts and attempted suicide than other professions (1). Additionally, studies across many countries, including Australia, have found that adverse patient outcomes are common in healthcare (2). Adverse patient outcomes significantly impact on the wellbeing of the clinicians involved, the “second victims”, as described by Albert Wu in his 2000 article Medical error: the second victim (3).
This stress is further exacerbated if the adverse event leads to a complaint or claim. Charles (2001) has reported that almost all clinicians will feel distressed as a result of litigation (4) and UK based organisation Doctors for Doctors lists the top two reasons for clinicians contacting their support service as career issues and being subject to a General Medical Council complaint (5).
Following receipt of a complaint or claim clinicians are impacted both personally and professionally by stress and distress. Relationships can also suffer as a result of the physical and mental wellbeing impacts described above. Cunningham (2011) has also noted the impact of complaint or claim on patient care, finding that reduced patient care can be an unintended outcome of complaints (6).
Navigating the process
If the complaint or claim has been triggered by a specific adverse event, you will likely feel impacted by the event immediately, prior to a complaint or claim being received. You may feel angry, frustrated or tense and perhaps be having trouble sleeping. Feelings of guilt and shame are common, your professional satisfaction may drop and you may start to develop symptoms of depression (7).
In addition to diminished professional satisfaction, it is common to also experience reduced confidence in your practice. This can be an ongoing issue, with around a third of clinicians feeling impacted for up to a year following an incident (8). If you feel that you are not to blame either wholly or in part for the incident you may also be feeling victimised.
So, what should you do about this? Firstly, it is important to seek information about the process of investigation of the complaint so you know what to expect. Your indemnifier, employer or legal counsel can help you with this.
Secondly, being aware of your emotional reaction to the situation and how this may affect your work is vital to being able to maintain your own health and wellbeing. Make an appointment with your GP to discuss your situation and gain support. If you do not have a GP, get one. Your GP can help decide whether it is appropriate for you to access further support. Regardless of whether or not you decide to access further support, and what type, it is helpful to have an external, objective professional help you make these decisions.
There are many services available to provide help to you at this time. Unsurprisingly, the evidence suggests that doctors who feel supported following an adverse event have better long term outcomes than those who do not (9). Counselling may be available via your indemnifier, employer or via a funded service. See the Resources list for some suggestions. It is also a good idea to seek additional support from friends and family, who may be able to provide you with an empathetic understanding of the situation and provide emotional support throughout the process.
It is very important to choose healthy ways of maintaining your wellbeing during this highly stressful time. Manage your work-life balance proactively; make time for physical activity each day (just a 30 minute walk if that is all you can fit in), eat well and try to get enough sleep. Looking after your physical wellbeing will have flow on effects to your mental resilience and ability to cope with the emotional stress associated with the complaints or claims process.
Be aware that an emotionally stressful event, whether related to your professional practice or not, increases your risk of being involved in a complaint or claim. Since one of the most significant risk factors for complaint or claim is a previous complaint or claim (10) using the above strategies to keep stress levels as low as possible is essential.
An opportunity to reflect
While all of the above information will be helpful to any clinician experiencing a stressful event, if you have received repeated claims or actions you may find it helpful to reflect on the individual circumstances of each complaint and/or claim and seek further advice and support to reduce your risk of future actions. Doing this can be of great benefit to you both personally and professionally.
Research shows that a significant proportion of repeated claims are associated with doctor-patient communication issues (11). If you have been subject to one or many complaints or claims where communication issues can be identified as a contributing factor you may be able to proactively reduce your risk of future claim by improving your interpersonal communication skills. Contact your indemnifier to ask if they have a programme available.
If you would like advice about Cognitive Institute programmes that might be helpful, please contact us for further information.
- In addition to providing medicolegal assistance, your MDO may offer access to a counselling service eg, MPS members across the world can access the MPS worldwide counselling service
- If you are a hospital employee you may be able to access an employee assistance programme, check with your HR department
- Doctors Health Advisory Service (Australia and New Zealand)
- AMA Doctors’ Health page
- Have a GP and see them regularly
- Debrief with a trusted colleague
- Access additional support if you need it (see above)
- Don’t self-medicate
- Take the time to find out what to expect throughout the process, your medicolegal adviser or employer can help with this
- Be aware that you are at increased risk for a subsequent claim throughout this period
- Beyondblue, National Mental Health Survey of Doctors and Medical Students, October 2013, available at www.beyondblue.org.au
- Levinson W, Disclosing medical errors to patients: A challenge for health care professionals and institutions, Patient Education and Counseling, 76(2009) 296-299
- Wu A, Medical error: the second victim, BMJ, 2000(320):726-7
- Charles S, Coping with a medical malpractice suit, West J Med 2001;174:55-58
- Gillespie G and Williams S, The pressure point: living and working with stress,Casebook United Kingdom, 19(3): September 2011
- Cunningham W and Cookson T, Addressing stress related impairment in doctors. A survey of providers’ and doctors’ experience of a funded counselling service in New Zealand, N Z Med J, 122(1300):2009
- Cunningham W and Wilson H, Complaints, shame and defensive medicine, BMJ Qual Saf 2011;20:449-452. Doi:10.11.1136/bmjqs.2011.051722
- Wachter R and Wu A, In conversation with … Albert Wu, MD, MPH, May 2011, podcast accessed 15 April 2014
- Wu in Wachter R and Wu A, In conversation with … Albert Wu, MD, MPH, May 2011, podcast accessed 15 April 2014
- Wu quoting Scott et al (2009) in Wachter R and Wu A, In conversation with … Albert Wu, MD, MPH, May 2011, podcast accessed 15 April 2014
- O’Brien M et al, The clinical communication program: an effective intervention for reducing future risk for high-risk physicians, Asia Pacific Journal of Health Management 2014;9:1