Relatively few doctors get a majority of patient complaints

By Peter Sergo, medwireNews Reporter

A minority of doctors in Australia elicited a disproportionate number of patient complaints, a study reports in Quality and Safety in Health Care.

"The extent to which complaints were concentrated in a small group of doctors was striking [and] consistent with other studies of complaints and claims," write David Studdert (University of Melbourne, Australia) and colleagues.

Researchers assessed a national sample of 11 years worth of formal complaints (n=18,907) that patients filed with a health service commission against 11,148 doctors.

Of all the complaints, 61% concerned clinical aspects of care, which mostly involved treatment, diagnosis, and medications. Another 25% identified communications issues, such as a doctor's attitude and manner, or quality and amount of information provided.

While an average of 1.98 complaints were made against all the doctors in the sample, 15% of doctors who were complained about accounted for 49% of the grievances while 4% accounted for 25%.

In general, 3% of all practicing doctors garnered half of all complaints while 1% accounted for a fourth.

A multivariate analysis calculated that doctors with two complaints were almost twice as likely to receive another complaint as doctors with just one complaint, while the chances increased sixfold for those with five previous complaints.

Compared with general practitioners, plastic surgeons had a twofold chance of getting a complaint, while dermatologists and obstetrician-gynecologists had a 50% higher risk.

Male doctors had a 40% higher risk for another complaint than female doctors, while doctors older than 35 years had a 30 to 40% higher risk than their younger counterparts. Conversely, location of practice (urban vs rural) played no role.

Doctors who reached three complaints had a 38% greater chance of being complained about again within a year, and a 57% greater chance within 2 years.

"Identifying and intervening early with doctors at high risk of attracting recurrent medico-legal events has considerable potential to reduce adverse events and patient dissatisfaction system-wide; it may also help those doctors avoid the vicissitudes of medico-legal processes," the authors conclude.

In an accompanying editorial, Ron Paterson (University of Auckland, New Zealand) recommends that a certain threshold number of complaints against a doctor should make the number and nature of the matter become public record and prompt closer scrutiny by a medical board.

Early complaints should also be treated as warning signs that elicit action from colleagues to prevent ensuing treatment problems, Thomas Gallagher (University of Washington, Seattle, USA) stated in another editorial.

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