The effect on New Zealand general practitioners of receiving a complaint from the (former) Medical Practitioners Disciplinary Committee

Abstract

There is evidence from the literature that in both litigious and non-litigious cultures, there is an effect on the person of the doctor that is associated with either the threat of litigation, or a perceived threat to the doctor-patient relationship. Furthermore, such threats are associated with the practice of negative defensive medicine. There is a paucity of literature in an Australiasian context on the effect of receiving a disciplinary complaint in general practice. This study investigated the effect on general practitioners of receiving a complaint from the (former) Medical Practitioners Disciplinary Committee, that did not proceed to a formal hearing. It examined the effect of such complaints on doctors and their practice of medicine in New Zealand.

This study used the qualitative research method of in-depth semi-structured interviews with transcript analysis, and the development of a theory to enhance understanding of the results. Ten New Zealand general practitioners responded to an invitation to participate in this study. All had had a disciplinary complaint considered by the Medical Practitioners Disciplinary Committee within the last five years. Telephone interviews were conducted by the investigator. Transcripts of the interviews were thematically analysed and the results returned to the participants for their further input.

There was evidence of 1. An immediate impact on the person of the doctor showing an intense negative emotional response associated with feelings of guilt and questioning of self. 2. An immediate impact on doctors' practice of medicine that was associated with a reduction in their capacity to practice medicine efficiently and to tolerate uncertainty in the consultation. 3. An immediate impact on the doctor-patient relationship that not only related to the complainant but to a reduction in the level of trust that doctors were able to bring to subsequent doctor-patient relationships. 4. An immediate impact on doctors' relationships with their spouse, family and colleagues in the direction of help seeking behaviour that indicated an immediate need for meaningful support. The results further indicated a significant long-term impact of the complaint on: 1. The person of the doctor that indicated a persisting emotional response, a change in the way in which they perceived themselves as doctors and a general erosion of goodwill towards patients. 2. A significant impact on doctors' practice of medicine characterised by the development of strategies to reduce the risk of recurrence of a complaint, that mostly took the form of negative defensive medicine. 3. A significant long-term negative effect on the doctor-patient relationship with patients other than the complainant. 4. A change in doctors' perceptions of other doctors who have had a complaint.

The results indicated a change in the participant's perception of their role as a doctor and their place in society and of their need for skilled advocacy throughout the disciplinary process, a process for which they felt ill prepared. Positive effects of the complaint emerged as a testing or vindication of their practice of medicine. The results indicate that the changes in the person of the doctor are consistent with those of shame as an emotional response to the receipt of a complaint. The long-term changes in their practice of medicine are consistent with the shaming response. The results indicate a need for the impact of a disciplinary complaint to be recognised by the medical profession, and for changes in the way in which the profession responds towards those doctors who have received a complaint. There is a need for an immediate appropriate and highly co-ordinated response to effectively meet the needs of doctors on a receipt of a complaint. The author presents a case for this being the responsibility of the Royal New Zealand College of General Practitioners and the Medical Defence Societies providing legal representation. To fail to acknowledge the impact of a complaint on the person of the doctor and the doctor-patient relationship, is to perpetuate a system that ultimately impacts negatively upon patient care