Wellness - individual

The email no clinician wants to receive…

“Private and confidential – Notice of a referral to the Australian Health Practitioner Regulation Agency”

Is there a more terrifying subject heading sitting in your email inbox? Perhaps, but I have (fortunately) yet to encounter it. I was a recipient of such an email, and it was devastating.

The details of the case aren’t really important, other than to say that I truly didn’t expect a complaint from this particular patient. In fact, I had spent what felt like a generous amount time with this patient during what was a very busy evening shift. We had discussed pros and cons of investigation options, and I thought we had come to a joint decision that the patient was comfortable with. Unfortunately, the patient was subsequently confirmed to have the serious pathology which they were worried about, and understandably they were frustrated and disappointed.

There are several things to consider when you receive notification of a patient complaint.

Who do you need to inform?

Firstly, your employer will almost certainly have a clause in your contract which requires that you notify them immediately of any notification to a regulatory authority. This means notifying your Director and probably your Director of Medical Services. AHPRA will then also ask you to provide a list of all of your current employers, including those for whom you provide volunteer services e.g. professional colleges, universities, and any other groups you work with. This part was particularly gutting. Having a complaint made about your care is confronting enough; having to disclose it to everyone with whom you have a professional relationship was even worse.

There are good reasons for this of course. In cases of true misconduct where patients are at risk of harm, it is important for all employers to be made aware. The problem is that of the many doctors who will receive a complaint, nearly three quarters will have no further action taken (1).

You are not alone

In 2018/19 nearly 6% of doctors received a notification, and this figure has increased year on year. (1) This means that we all need to be prepared for this prospect. It also means that the chances are, at least one of your bosses will have gone through the same experience you have. For me, I was surprised and touched by the empathy and compassion shown by my colleagues. They understood the impact this notification may have on my confidence and identity, and explicitly stated that they had confidence in me as a doctor and, more importantly, as a person – and offered an ear and chat anytime I needed it.

Who are you “allowed” to discuss your experience with?

There was one more thing I was worried about- even more than having to tell my bosses: I was concerned that I would be told that I couldn’t talk to anyone about what was happening. I had supported a colleague who had gone through a similar process in the previous year, and they were required to sign a confidentiality clause prohibiting them from discussing the case with anyone other than their Medical Defence Organisation (MDO). Fortunately they had reached out prior to this clause being signed, which allowed us to continue to chat and for that colleague to vent and debrief. I knew that I would need to be able to talk to friends and colleagues if I was going to get through this process intact. So I decided to reach out early before I was potentially gagged. This was almost harder to do than notifying work. I am so fortunate to have an amazing group of family, friends and colleagues. All were incredibly supportive and made this stressful experience bearable.

Use the expertise of your MDO

The other major source of support was my MDO. They were superb and completely normalised the process as well as providing invaluable advice regarding the mechanics involved with responding to AHPRA and what to do next (2). They also offered a peer support program, which allowed me to speak to another doctor about what I was experiencing. Interestingly (and sadly) they told me that some doctors found a notification, even about a trivial matter, incapacitating and led to their departure from medicine. Others would be oblivious to the seriousness of their complaint to the point of potential danger to themselves and their career.

What happened next for me?

I wrote a detailed response and included a letter of support from my director (which was difficult to ask for, but given without question). I then waited. And waited. And waited.

The process of notification of employers, friends and colleagues began again, but fortunately this time for more positive reasons.  It did remind me however of how many people I had to notify throughout this process, and how relieved I was that this was now complete. Fortuitously, the whole process was completed within a single registration period, so that I wasn’t required to indicate there was a notification when I completed my annual registration declaration.

So, why did I write this post?

Well, I wanted to share my story to help eliminate some of the shame and secrecy around this topic for doctors. Some of you will have gone through what I and many others have gone though. If you haven’t yet, recognise that you almost certainly will at some point.

You may feel the intense embarrassment and shame that I did. Shame is like a bolus of corrosive sitting in your stomach and gnawing away. Open discussion and exploration of these experiences in a safe environment is the antidote to this toxin.

I also wrote this because it may help some of you who may besupporting a colleague going through this process. I appreciated the kindness and affirmation I received from my colleagues and friends more than words can describe, and I’m not sure I ever said thank you. Being able to discuss what I was going through was so helpful, and it helped me no longer feel ashamed.

In the event that you receive a complaint, please be kind to yourself and others. This is an incredibly difficult experience, but you will learn and grow from it – I certainly did. And if you’re not yet a member of an MDO now is the time to join!

References

  1. Australian Health Practitioner Regulation Agency – Health complaints entities [Internet]. [cited 2015 Jul 14]. Available from: http://www.ahpra.gov.au/Notifications/About-notifications/Working-with-health-complaints-entities/Health-complaints-entities.aspx
  2. Managing the Stress of Complaints – MDA National [Internet]. [cited 2020 Mar 2]. Available from: https://www.mdanational.com.au/advice-and-support/library/blogs/2018/09/managing-the-stress-of-complaints

Resources

www.mdanational.com.au

www.avant.org.au

www.mips.com.au

www.dhas.org.au

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