UK Study Explores Impact of Malpractice Stress

A problem must have a name and definition to be solved, and the increased stress experienced by medical practitioners can only be addressed if its parameters are well defined. One defined source of stress is being named in some kind of official complaint.

A recent study surveyed 7,926 United Kingdom physicians, one cohort of whom had a recent or past complaint filed against them and another cohort of those who had not (Synopsis: The impact of complaints procedures on the welfare, health and clinical practice of 7926 doctors in the UK: a cross-sectional survey. Bourne T, Wynants L, Peters M, et al. BMJ Open 2015 Jan 15; PMID 25592686). The definition of complaint varied greatly, the most serious being a referral to the General Medical Council (GMC) which has the power to regulate medical practice by imposing warnings, suspensions, restrictions or, in some cases, loss of license. Lesser complaints involved internal inquiries, and disputes within the hospital as well as investigations into serious untoward incidents (SUI). Although referrals to the GMC have increased dramatically (by 18%) in recent years, most of the serious complaints resulted in “no action taken.”

Although causation is not applied, the authors found that 16.9 percent of physicians with a recent or ongoing complaint reported symptoms of moderate or severe depression as measured by the Physical Health Questionnaire (PHQ-9). 15 percent of this same group reported clinically significant anxiety as measured by the Generalized Anxiety Disorder scale (GAD-7). Symptoms including general medical complaints and suicidal ideation were more likely to develop with more serious complaints (referral to GMC).

The authors suggest that these findings parallel the experience of American surgeons who have been sued and are coping with malpractice (Personal Consequences of Malpractice Lawsuits on American Surgeons, J Amer Coll Surg 213 (2011) pp.657-667; PMID 21890381). Similar to their American counterparts, these doctors engaged in symptoms associated with medical malpractice stress syndrome: defensive medical practices, symptoms of burnout and an increased vulnerability to medical errors. The authors question the emotional cost versus the benefits of a system of medical practice regulation that has the potential of harming patient care and patient safety.

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