Saturday, January 23, 2016

When is a doctor like a bull ant?

In my previous post, I addressed the issue of bullying in Australian hospitals.  In an article published three years ago in BMJ Quality and Safety, Marie Bismark, David Studdert and colleagues addressed a topic that might be correlated in some way with that problem--or might just have importance in it own right.

The authors' objective was: 1) To determine the distribution of formal patient complaints across Australia's medical workforce and (2) to identify characteristics of doctors at high risk of incurring recurrent complaints.

What they found was:

A small group of doctors accounts for half of all patient complaints lodged with Australian Commissions. 

The distribution of complaints among doctors was highly skewed: 3% of Australia’s medical workforce accounted for 49% of complaints and 1% accounted for a quarter of complaints. Short-term risks of recurrence varied significantly among doctors: there was a strong dose-response relationship with number of previous complaints and significant differences by doctor specialty and sex. 

The research suggested:

It is feasible to predict which doctors are at high risk of incurring more complaints in the near future. Widespread use of this approach to identify high-risk doctors and target quality improvement efforts coupled with effective interventions, could help reduce adverse events and patient dissatisfaction in health systems.

The Australian bull ant (seen above) gets you coming and going.  He'll either bite you from the front or sting you from the back. This cadre of doctors do the job even better. They offer the potential of both harming the patient and the institution in which they work.

Thus far, though, "the medico-legal enterprise remains reactive, dealing primarily with the aftermath of adverse events and behaviours that lead to costly disputes." Perhaps the work produced by Bismark, Studdert and colleagues will help the AMA, health services, medical indemnity insurers, and others think more systematically about this issue.  And, as in the bullying case, the input of patients and families could certainly prove valuable in this arena.


Beverly said...

From Facebook:

I suspect these doctors are identifiable as early as medical school or residency. While I agree that medical training should be modified to prevent such behavior, early intervention in the meantime, before they have significant opportunity to harm patients and colleagues, could help.

Anonymous said...

The problem is telling admin that. They won't do anything but hide the problem, and trash the patient. What you need is a system where the admin is forced to discuss the problems and fix them to where the patients are not penalized for the issue. It can be done, the problem is the administration that refuses to do the right/ethical thing and the legislators bought by the lobbyists, who sit around and talk but no action or won't listen to the regular people.

That situation holds true at least for a number of instances in Va.