We’ve heard all about responsible doctors. This is why patients must be held accountable.
“I saved a voicemail for you,” my friend says over a hastily arranged lunch. After ordering I pressed play and listened not once, but three times. The message is like a poorly microwaved meal: warm on the surface, stone cold on the inside.
The caller is the Australian Health Practitioner Regulation Agencythe authority that ensures that the public can maintain confidence in the medical profession.
In the message, a man politely informs me that a complaint against my friend is underway. He acknowledges that this could be stressful news and urges her to avoid stress, though he doesn’t suggest how she might do that amid the mystery surrounding the report.
She spends the night terrified. Unhappy and dissatisfied patients from 25 years of practice race through her head. In her habit of apologizing and fixing things, did she offend anyone so seriously that it led to a complaint?
The next morning, after a distracted drive, she sees patients she couldn’t cancel. When her inbox pings, she waits for the last patient to leave. The email states that she is being assessed and will have two weeks to respond. To make matters worse, she must list all her workplaces so that the public is protected while she is investigated.
The complaint is surprisingly superficial. A patient has accused her of missing a diagnosis of chronic pain, which was correctly diagnosed a decade later, and wonders how she could have missed it.
My friend’s first reaction is that she can’t remember that patient. A search of her database turns up no such name, which causes dismay instead of relief. Why should a patient be wrong? Did the database lie?
She drives home late at night, hungry and tired, tells no one and crawls into bed for the first of many disturbed nights of sleep.
The next day she retrieves archived documents from the past ten years. Still nothing.
Perplexed, she eventually calls Ahpra and apologizes for not believing she knows the complainant.
The reaction is strange. A polite man says she may be right, but for the record, assuming it was her patient, she should explain to Ahpra how she would have dealt with his pain.
This suggestion makes a mockery of patient care. Chronic pain is as difficult to tolerate as it is to treat, and the treatments are as plentiful as the causes. How could a doctor blindly answer how she would treat a hypothetical patient?
Despite her enthusiasm to complete the case, she finds the advice so bizarre that she calls her health insurer. Her lawyer drafts a short response to Ahpra and says no thanks.
But then her expectations for a quick resolution are thwarted by an uncertain wait while the regulator and the Medical Board of Australia review the case.
Meanwhile, fear erodes her equanimity.
Why would anyone attack her? What if the supervisor discovers another error? Could she lose her driver’s license? And if not her license, then her reputation? If she loses her livelihood, who will pay the mortgage and school fees?
It is impossible to prevent the disillusionment from seeping into her attitude. She withdraws from seemingly nice patients and wonders who else will complain. After barely taking maternity leave and sacrificing many family occasions to serve the community, she kicks herself for a thankless job done at the expense of her personal life.
But only the best doctors to suggest If they care less, they never really stop caring. During the day, she fulfills her duty to patients, consistently overbooking and overworking. At night she loses sleep and peace of mind.
Ahpra advises doctors who are under investigation to talk to their friends in the same boat, but unfortunately they also have stories of misery.
Like the story about my cancer patient who repeatedly missed appointments. My pleas to see me (or anyone else) were met with her refusals. Then she became terminally ill and complained that I had been negligent. My empathy crashed with a proverbial slap in the face; the burden of proof was on me.
Doctors fear that until they are acquitted, it is uncertain how even the most unfounded complaint will play out. The only consolation I can give my suffering friend is that she is so good that other doctors choose to see her.
The balance of power between doctors and patients, and the enormous harm that some patients suffer at the hands of a few doctors, rightly means that a high standard of care should be imposed on all doctors. But it’s a broken system that holds doctors accountable, but not their patients.
Ahpra says that annoying complaints make up less than 1% of reports. Doctors combat this with a survey among 1,290 general practitioners showing that 80% believed that they had received such a complaint.
Patients have registered complaints for being denied a script, a disability certificate or medical leave and for being asked to wear a mask in the waiting room. Each complaint takes hours of paperwork and months of anxiety to refute.
Doctors are concerned about Ahpra’s annoying notification system may not work as it should.
Why this is important to society is that unfounded complaints cause enough psychological damage to drive doctors away, leaving entire communities without proper medical care. Therefore, complaints should be monitored and assessed, complainants should be educated about their responsibilities, and doctors should not be made to feel guilty prematurely.
After months of uncertainty, Ahpra tells my friend to relax. There is no reason to answer because she told the truth. She would like to know what consequences the patient faced for making a seemingly unfounded accusation and how other doctors could be protected from her experience.
My friend absorbed the cost and the fear. But next time she might just quit, and we would have to mourn that, if the complaints process is flawed, the patient gains nothing and the community loses a good doctor.