Sitting at his desk in the Medical Protection Society, Richard Stacey regularly takes phone calls from doctors facing complaints from patients. Every year, the number of calls keeps rising.
Researchers warn that the complaints are exacting a heavy toll. Twenty-eight doctors facing investigation, according to General Medical Council (GMC), took, or are suspected to have taken their own lives between 2005 and 2013.
In all, nearly 100,000 doctors were polled by the BMJ Open. Nearly one in six of those facing a complaint reported they were moderately to severely depressed. Such doctors were twice as likely to harbour thoughts of self-harm as those not facing complaints.
"I try to tell people that the very attributes that make people good doctors – conscientiousness, a caring attitude – are also the traits that make them very vulnerable when things go wrong," Stacey told The Irish Times.
In 2013, nearly 10,000 complaints were made against doctors in the UK, including Northern Ireland. Since 2010, the number of reports from patients has jumped by 43 per cent.
In the past, patients were too deferential when dealing with doctors. Now the pendulum sometimes swings in the other direction, Stacey said. “People live in a Trip Advisor world, where they are used to pronouncing judgment.”
Doctors’ fears
The General Medical Council intends to change some of its procedures during investigations. Letters to doctors will be written more sensitively. Equally, it will try to cope with doctors’ fears that they be treated as “innocent until proven guilty”.
Investigators should have up-to-date experience with the conditions faced by GPs, who are seeing significantly larger numbers of patients than they did even a few years ago – despite ever-present complaints in Britain that one can never get in to see a GP.
“I’ve seen 44 patients today,” a GP described this week. “I have about 50 results and the same amount of letters in my tray, all a banana skin [for] medico-legal risk. I estimate at least 10k phone and face to face consultations/ year, let alone all the other work completed.
“If they want to drive up professional standards they need to drive down the numbers we see. But as I found out to my cost one slip-up and it mattered not one jot the circumstances of my failure or the number of people seen. Screwed!”.
In some cases, doctors who later committed suicide had underlying issues, according to the GMC. Many suffered from depression. Some had drug or alcohol addictions. Others faced hardship, marriage breakdowns or had come to the attention of the police.
28 days to respond
Still, the investigation rules contribute to stress. Inquiries can take a year, but doctors are given just 28 days to respond to reports,” said Stacey. “Also, the GMC writes to a doctor’s practice or their employers to find out if they have had any complaints against the doctor.”
The latter change was brought in for good reasons, in the wake of the 2000 conviction of Dr Harold Shipman on 15 counts of murder – though it is believed that the Manchester GP may have killed as many as 250 elderly victims.
Complaints are often sparked by poor communications. “Doctors have to keep records,” Stacey said. “Often they are typing in details as the patient tells them their story. No eye contact is made by some doctors, so the patient feels that they have not been heard properly.”
“Everybody accepts that complaints should be investigated properly. There is no issue about that. But doctors end up complaining about sleepless nights, or about fears about being struck off, or that they will lose their home.”
Most cases lead to no such outcomes. Three-quarters are closed with a decision that no further action be taken, or with recommendations that the doctor should improve relatively minor matters.
In 2013, 229 cases were investigated by fitness-to- practice panels. Of these, 55 doctors were struck off, four volunteered to quit, 86 were suspended, and 32 were allowed to continue practicing under supervision.
In Westminster this week, the new head of the GMC, Terence Stephenson, told MPs that doctors should now regard a council investigation as “an occupational hazard” during their career, and be better trained to withstand it.
Stephenson has twice faced a GMC investigation, each time successfully. Today, he believes doctors should look to the British Army’s experiences in Afghanistan.
“They don’t wait until they arrive in Helmand Province. They start in recruitment and training.”