Thursday, April 18, 2013
QD: News Every Day--3% of doctors generate half of all complaints
Only 3% of all doctors generate half of patient's complaints, while 1% generate one-quarter of them, an Australian study found.
To determine the distribution of formal patient complaints in Australia and identify characteristics of doctors who are at a high risk of incurring repeat incidents, researchers sampled nearly 19,000 formal patient complaints filed against doctors with ombudsmen in Australia over an 11-year period. These ombudsmen are statutory agencies established in each of Australia's six states and two territories.
Results appeared online April 10 at BMJ Quality & Safety.
Sex mattered; 79% named in complaints were male and men had a 40% higher risk of recurrence than women (HR 1.36; 95% CI, 1.23 to 1.50).
Specialty mattered; 47% were general practitioners and 14% were surgeons. Compared with general practitioners, plastic surgeons had twice the risk (HR, 2.04; 95% confidence interval [CI], 1.75 to 2.38), and dermatologists had more than a 50% higher risk (HR, 1.56; 95% CI, 1.30 to 1.88), as did obstetrician-gynecologists (HR 1.50; 95% CI. 1.29 to 1.76). Anesthetists had significantly lower risks (HR 0.65; 95% CI, 0.54 to 0.79).
Doctors in the sample incurred complaints an average of 1.98 times (SD 2.31), with a wide range of less than 10% risk of further complaints within two years to a greater than 80% risk. Doctors named in a third complaint had a 38% chance of having a further complaint filed within a year, and a 57% probability of being complained against again within 2 years.
Not surprisingly, the more complaints, the higher the risk. Doctors named in a fifth complaint had a 59% probability at one year and a 79% rate at two years. Researchers noted that recurrence was "virtually certain" for doctors with 10 or more complaints, with 97% incurring another complaint within a year. Regardless of the number of previous complaints, doctors' risks of further complaints increased sharply in the first 6 months following a complaint, but then plateaued and declined steadily thereafter.
Among doctors with complaints filed, 15% accounted for 49% of all complaints, and 4% accounted for a quarter of all complaints. But across the full population of practicing doctors, including those without complaints filed, 3% accounted for that 49% figure, and 1% accounted for that one-quarter of all complaints.
Among the reasons for complaint, 61% related to clinical aspects of care, most commonly concerns with treatment (41%), diagnosis (16%) and medications (8%). Nearly one-quarter of complaints dealt with communication issues, such as attitude or manners (15%), and the quality or amount of information provided (6%).
The problem might be manageable, researchers noted, since fewer than 500 doctors accounted for one-quarter of complaints.
They wrote, "A more sobering implication of the clustering phenomenon is that remediation activities targeted at doctors who have attracted many complaints, while critical, come too late. Complaints are best understood as sentinel events, and complainants as representatives of much larger groups of harmed or dissatisfied patients. By the time multiple complaints have accrued, substantial damage to quality of care is likely to have occurred already. The clustering of medico-legal events highlights the huge gains that would be put in reach by a capability to identify early doctors who are on course to incur multiple complaints."
Contact ACP Internist
Send comments to ACP Internist staff at firstname.lastname@example.org.
- Say it ain't so, HIPAA!
- The newest tool to prevent infections
- QD: News Every Day--Knowing costs makes providers ...
- Medical regulations run amok!
- #sellingsickness 2013
- The clinical skills exam--feh!
- Azithromycin might kill you, but that's not why yo...
- IM 13: Scrutinize what you sign when authorizing r...
- IM 13: Dedication to the cause
- IM 13: Are you screening all adult patients for HI...
Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.
David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.
Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.
Reflections of a Grady
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.
The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.
Technology in (Medical)
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.
Peter A. Lipson,
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.
Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.
Other blogs of note:
American Journal of
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.