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.