Blog | 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."