- Handling and responding to complaints can be stressful.
- Seek help if you need it, and do it early.
- One adverse incident can lead to multiple investigations.
- Stress can affect both doctors and patients.
Responding to complaints and investigations is part of being a doctor, but while it's important to act on any errors identified and learn from them, these investigations also can be very stressful for the doctor involved.
Doctors already have to cope with the stress of high pressure environments and heavy workloads. This can easily be compounded by the duty to respond to complaints and cooperate with formal inquiries like inquests, adverse incident investigations, GMC complaints and Ombudsman's investigations.
This added stress can have significant consequences, and sickness rates among healthcare workers are regularly reported to be much higher than in other areas of the economy. For example, a 2017 survey found that one in 10 GPs took time off work in the previous 12 months because of stress or burnout, with a further 22% fearing they would do so over the following next year.
As well as affecting doctors' own health, stress factors can affect their clinical judgement and ability to deliver safe, effective care to patients.
In our experience, it's not unusual for one incident to lead to several separate investigations. We call this multiple jeopardy. This can be particularly stressful for the doctor concerned as the different investigations can take much longer to complete than just one.
Depending on the circumstances, a single clinical incident could lead to:
- civil claim
- criminal investigation
- disciplinary investigation
- NHS complaints procedure
- GMC investigation
- coroner's inquest/FAI (in Scotland)
- CQC inspection (in England)
- media attention.
Recognising the stress caused by its investigations, the GMC announced additional measures to support doctors going through fitness to practise procedures. You can read more about this in our digital journal.
With complaints and claims rising, the numbers of doctors affected by investigations continues to increase, so developing a coping strategy must be high on all doctors' agenda.
Every year, the MDU supports thousands of members responding to complaints and investigations and can provide help throughout what can seem at times to be a prolonged process.
Here are some recommended steps that may help to reduce the impact of a medico-legal investigation on your life, wellbeing and performance.
Contact us as soon as you become aware of an investigation or complaint, or an incident that might lead to one. We can tell you what to expect and the process that will follow, and this can remove some of the fear of the unknown. We can also help you to plan your response with the assistance and support of an adviser.
Talk to colleagues
Discussing concerns and complaints with colleagues is an important part of reflecting on performance and reviewing patient feedback.
They can understand the extra pressure an investigation places on you and help you to identify learning points to be shared with a wider group, if appropriate. They can also help you keep things in perspective by giving you positive feedback when things go well.
Colleagues may also be able to tell if stress is starting to affect your performance. Be willing to listen and respond to their concerns.
Get support from family and friends.
Patient confidentiality places limits on what you can share, but families and friends are still an invaluable source of support. It's understandable to protect those close to you from worry, but work stresses can often spill over into your home life, so it's best to share your concerns.
Make sure you're registered with a GP
As a profession, we are not always very good at recognising when to seek medical help ourselves. Your own GP can give you objective advice and refer you for further support if needed. Arranging an occupational health assessment could also allow reasonable adjustments to be made at work.
With either, it's best not to set too high a threshold for talking about the pressures you're under.
Consider getting extra emotional support
The GMC has set up a confidential support service in conjunction with the BMA called the Doctor Support Service. Any doctor who's had a complaint made about them to the GMC can contact the service by phone or email.
The BMA also runs its Doctors Adviser service, providing confidential advice to doctors and medical students in difficulty.
It can be difficult not to take a complaint or claim personally, even though the investigation itself may seem incredibly impersonal.
Taking advice from those used to dealing with such cases can remove some of the stress caused by the unknown, but the extra support of family, friends, colleagues and other professionals can be invaluable in maintaining your own confidence and protecting your physical and mental health.
Remember the MDU can guide, support and defend you through every stage of dealing with a complaint or claim. If you need help, you can contact us here.
This guidance was correct at publication 01/08/2019. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.