This article was first published in Australian Doctor, and has been republished by the NSW Medical Council with kind permission of Australian Doctor and Avant.
The possibility of missing a diagnosis would have to be one of the major things that keeps doctors awake at night, and mistakes that might have been made with regard to medication would probably be high on the ‘anxiety list’ as well.
After analysing our own claims data at Avant, we found that a patient is equally likely to have a grievance about their GP's behaviour (23% of cases) as they are about either misadventures with medication (22%) or diagnostic issues (23%).
In an AHPRA podcast, posted last year, Dr Gerald Hickson — an expert on medical complaints — describes the concern patients feel when their expectations of professional behaviour have not been met.
Complaints relating to practitioner behaviours usually include issues around communication, attitude and manner. While it may be tempting to see this as distinct from complaints about clinical issues, the separation may not be so clear.
Claims commonly involve multiple issues, and our analysis suggests a doctor’s behaviour is often raised in the context of another clinical concern.
This is consistent with international research that has identified a correlation between rude or unprofessional behaviour and the likelihood of a medicolegal complaint.
The hypothesis has generally been that a poor relationship between patient and doctor means a patient is more likely to bring a claim if they experience an unexpected outcome.
A doctor’s perceived rudeness may mean the patient did not understand the treatment options being presented, what outcomes they could expect, or felt unable to ask the questions they wanted to.
Poor communication after something goes wrong may also increase the risk of a complaint, particularly if patients and families feel information has been withheld.
Every GP will have faced patient communication challenges. They can happen when declining to write prescriptions for antibiotics or drugs of dependence, or during tough conversations about treatment options.
So complaints about allegedly poor behaviours may be due to having to tell a patient something they do not want to hear.
However, our data indicated that in more than one-third of relevant claims, the doctor’s communication was found to be below the expected standard of care.
Communication is an essential aspect of patient care — from obtaining history to recommending and obtaining consent to treatment.
So problems with communication at any stage can lead to a greater chance of an unexpected outcome.
Patient complaints about diagnostic errors can be wrapped up in a failure to heed patient concerns. They can also be wrapped up in allegations the doctor had failed to convey information or results.
Rude and disrespectful
Everyone may have an off day from time to time, or something they say may be misinterpreted.
However, research into concerns about professional behaviours suggests concerns arise about persistently rude and disrespectful behaviour, observed by patients and/or colleagues on multiple occasions.
Recent analysis of data from two major US teaching hospitals found that where surgeons had been the subject of more frequent complaints about rude or unprofessional behaviour, their patients were significantly more likely to experience surgical or medical complications.
While the studies report a correlation, it remains unclear what the causal factors are.
But complaints about communication and behaviours are now being taken seriously as an indicator of risks to patient safety.
Below, we list three strategies you can adopt.
Listen. Even if you feel pressured, try to take the time to listen to a patient’s concerns. You may gain greater insight to help avoid a risk, or it may ensure the patient feels they have been heard and treated with respect. In either case, listening will almost always pay off.
Respect. Whether or not you agree with a patient’s treatment decisions, try to step back from your own views and remember they are the patient’s choice. Your role is to make sure you have done enough to give them the information and understanding they need.
Practise self-care. Stress that is directly attributable to the COVID-19 pandemic may be exacerbating communication challenges, which is why it is more important than ever to reinforce the message that being well yourself is also essential for patients’ wellbeing. This is not just about coping and being able to put up with stress.
Dr Geoff Toogood, cardiologist and founder of Crazy Socks 4 Docs, the campaign group fighting to improve mental health care for doctors, says resilience is built through the support of a ‘village’ — it isn’t an individual problem.
So above all, find your own GP, seek help from them and look out for colleagues.
Melissa Yee is a research and evaluation manager at Avant; Eunice Ku is a claims analytics manager at Avant.