Medical Council publishes research on doctors and complaints process

WEDNESDAY DECEMBER 13 2006

Managing Complaints about Doctors: Stakeholder Perspectives of the Role of the Medical Council in Ireland, the first ever report of its kind, was launched today by the Minister for Health and Children, Mary Harney TD. The study was commissioned by the Medical Council. It publishes key findings on medical regulatory issues and identifies their implications for the new Medical Practitioners Bill and the broader complaints system.

The study surveyed 476 stakeholders, including 35 hospital managers, 250 members of the public, 74 complainants to the Medical Council and 117 doctors complained against to the Medical Council. The Health Services Research Centre at the Royal College of Surgeons in Ireland (RCSI) conducted the research - Ms Siobhan McCarthy, Prof Hannah McGee and Prof Ciaran O'Boyle led the study.

The President of the Medical Council, Dr John Hillery, said the results of the research were very timely and he said he hoped its conclusions would be taken on board in the upcoming new Medical Practitioners Bill. "The research shows clearly that there must be continuity and transparency in complaints procedures," Dr Hillery said. "Some of the criticism of the current procedures for complaints is warranted and as the research shows, arises from the out of date nature of the existing legislation."

Dr Hillery added: "Though medical regulation must be about more than fitness to practice, mechanisms for the assessment of individual doctor's fitness to practice must be a core of any regulatory system. These mechanisms must ensure that patients are not exposed to people who may do them harm and must be fair to doctors, dealing firmly with those who have a case to answer and not traumatising those who are innocent. The research will inform the development by the Medical Council of more user-friendly systems for both patients and doctors and highlights the need for systems that do not need the full impact of the Council's Fitness to Practise Procedures."

Professor Ciaran O'Boyle, Head of the International School of Healthcare Management at the RCSI and one of the co-authors of the report, said that as with other professions, self-regulation of the medical profession (monitoring of doctors by doctors) has been viewed with mistrust. "There is a general assumption that the absence of larger public involvement in medical regulatory process fosters the protection of doctors and the alienation of those who complain. However, this in-depth multi-stakeholder research on how the Medical Council manages complaints and on the broader complaints systems shows that this is not necessarily the case and that there are urgent and wider issues to be addressed."

Professor Hannah McGee, Chair of the Department of Psychology at the RCSI and another co-author of the report said the issues raised in the research indicate the necessity for agencies dealing with complaints about doctors to increase levels of transparency. "There is a need for greater accountability, to improve communication practices, to design effective complaints procedures and to have inter-agency co-operation. These issues require appropriate statutory changes."

Mr John Lamont, Registrar of the Medical Council said many of the recommendations made in the research report have already been taken on board by the Council. Explanatory leaflets for both complainants and doctors setting out the procedures of the Fitness to Practise Committee have been produced for dispatch to complainants and doctors on receipt of a complaint. In addition the website of the Medical Council (www.medicalcouncil.ie) is currently being updated to enhance the transparency of the complaints process.

The research mainly evaluated how the Medical Council has dealt with complaints under the 1978 Medical Practitioners Act. It did however test the levels of satisfaction with doctors. Eighty-four per cent of the public surveyed were satisfied overall with the care they received from doctors over the past five years. Complaints about doctors to hospital authorities constituted a minority (15%) of complaints received about hospital services.

While overall there was a high level of satisfaction with doctors, 25% of the public surveyed reported that they did have a reason for being dissatisfied with a doctor over the previous five-year period. These mainly concerned consumer issues such as cost, poor communication, etc. The research found that dissatisfied patients were unlikely to make a complaint and there was a very low level of awareness of the agencies responsible for dealing with complaints about doctors.

Some of the problems the research highlighted are rooted in the confines of the Medical Practitioners Act. In particular, the practice of examining all types of complaints under the charge of professional misconduct was identified as problematic, as was the process of corresponding with those who complain and those complained against by standardised legally formulated letters. The result has been that approximately 90% of complaints (e.g. lack of diagnosis, adverse outcome, poor communication) are deemed not to merit a fitness to practise inquiry, without adequate explanation to or appropriate communication with complainants and doctors complained against.

The study found that this has resulted in negative perceptions of the Medical Council among complainants and has contributed to the belief that doctors are unaccountable. Furthermore, while participating in the fitness to practise process was a largely negative experience for doctors, the problem has been that doctors complained against (83%) have been mostly satisfied with the outcome of the complaint, while complainants (81%) have been dissatisfied.

Reflecting the need for increased transparency, 63% of complainants disagreed with the statement that the Medical Council is a transparent organisation, the process of regulation is clear and explanations are given for decisions made. Of doctors complained against, 27% disagreed with this statement and a further 31% neither agreed nor disagreed or did not know.

A major finding of the study was that both complainants and doctors complained against largely agreed on the changes necessary to bring about regulatory improvements. The research concluded that there was a need for increased transparency, more pro-active systems for monitoring medical practices rather than relying solely on complaints, the need for a standardised inter-agency approach to dealing with complaints and the promotion of better communications skills and interpersonal skills in medical training.

Both complainants and doctors felt that examining all complaints under the charge of professional misconduct was inappropriate. Described by one complainant as "a doctor breaking a red light and being charged under the Murder Act", complainants felt that this approach made doctors accountable only for complaints about gross medical errors, which are in the minority. From the point of view of doctors, those who considered their complaints to be trivial or vexatious, felt it was unfair to be subjected to a stressful and lengthy statutory process when, in their opinion, it was obvious that a fitness to practise inquiry was not necessary.

Stakeholder recommendations focused on how to improve the complaints procedure and how it is experienced. Both predominantly viewed holding fitness to practise inquiries in public as problematic. Most supported public involvement in the regulatory process (97% of complainants and 75% of doctors). The survey of the general public showed that the majority (95%) favoured a system of more public involvement than at present (currently at least four out of twenty-five members are non-medical). However, most (82%) wanted this to be in conjunction with medical professionals in somewhat increased (40%) or in approximately equal numbers (42%).

The research did identify medical regulation challenges. The research showed the difficulty of ensuring that the outcomes of complaints processes are effective and worthwhile. For example, many complainants (81%) were dissatisfied with the outcome of the complaints process. Amongst other outcomes, they wanted the doctor to receive a warning and to be assured that the unsatisfactory practise would not be repeated or continued. Two thirds reported that they did not achieve any of the outcomes they wanted. In contrast, most doctors (83%) were satisfied with the outcome of the process. However, 20% were dissatisfied with how the Medical Council handled the complaint because they felt the Council processed trivial or vexatious complaints against them. Two thirds of doctors said they were more likely to practise defensive medicine as a result of the complaint. Complainants rated the Medical Council's complaints procedure highly in terms of principles of best practice in relation to its accessibility, simplicity, speed and confidentiality.

The report can be downloaded below:
Managing Complaints about Doctors: Stakeholder Perspectives of the Role of the Medical Council in Ireland.pdf