Claims and complaints insights: General practitioners

Claims and complaints insights: General practitioners

Summary:

What are the main issues driving general practitioner members' compensation claims and complaints? Find out the underlying themes and insights to reduce your risk of these types of claims and complaints, in our analysis.

GPsGeneral PracticeClaims insights
17 / 07 / 2020

One in 10 general practitioners had a matter in FY2018-19

One in 10 Avant general practitioner (GP) members had a matter raised about the provision of their care in FY2018-19. Matters were primarily regulatory complaints.

Doctors sometimes have allegations made against them even though they provided appropriate care.


The types of matters Avant assists general practitioners with include:

  • 57% Regulatory complaints
  • 15% Claims for compensation
  • 12% Coronial matters
  • 7% Employment disputes
  • 6% Medicare
  • 3% Other
 

*Data source: matters indemnified FY2015-2019

Our data analysis

The following retrospective review is of routinely collected and coded data and is based on over 4,500 matters involving Avant GP members across Australia. All matters were indemnified and closed over the five-year period from July 2014 to June 2019.


Common claims and complaints

The majority of medico-legal matters were compensation claims and regulatory complaints. These related to:

 
23%
Diagnosis
 
23%
Practitioner behaviours
 
22%
Medication-related issues
 
13%
Management/treatment
 
7%
Patient information/records
 
6%
Procedural/surgical
 
5%
Other

Diagnosis issues

23%

of claims and complaints were related to diagnosis issues. Of these:

4 in 5 diagnosis issues were allegations of a missed or delayed diagnosis. These primarily related to issues during:

  • Initial assessment e.g. failure or delay in referring for appropriate diagnostic testing; inadequate examination; failure to heed patient complaints or symptoms; or failure or delay in referring to specialist/hospital admission.
  • Testing and results e.g. incorrect interpretation of results.
  • Follow-up e.g. failure to follow up tests or action test results.

1 in 5 diagnosis issues were allegations of a misdiagnosis. These primarily related to issues during the initial assessment stage e.g. inadequate examination; or a failure or delay in referring for appropriate diagnostic testing.


Practitioner behaviours

23%

of claims and complaints were related to practitioner behaviours. These included allegations of:
  • Communication issues with patients e.g. failing to communicate information/results; rudeness; inappropriate comments.
  • Boundary transgressions e.g. inappropriate touching; inappropriate examination; treating a family member/close friend.
  • Poor attitude or manner towards patients e.g. lack of empathy/concern; other unethical behaviours/conflicts of interest.
  • Impairment e.g. psychological or cognitive impairment.

Medication-related issues

22%

of claims and complaints were medication-related issues. These were primarily related to:
  • Inappropriate prescribing of drugs of dependence e.g. oxycodone, diazepam.
  • Other prescribing issues e.g. inappropriate prescribing, refusal to prescribe, contraindicated medication, inappropriate change or cessation of dosage.

Are doctors meeting standards?

When a medico-legal evaluation of expected standards of care was conducted, the doctor was considered to have met the standard in nearly two thirds of cases.

63%

 

37%

 
Met the standard
Did not meet the standard

Key insights

According to our analysis, GPs are more likely to be subject to a complaint than to be sued. In the majority of matters we analysed, the GP’s care was found to meet the standard expected. However, experiencing a medico-legal matter is often stressful, even if your care is appropriate. Cases can often be prolonged due to regulatory and legal processes and can take years to resolve.

Diagnosis, practitioner behaviours and medication-related issues were the main types of allegations.


Missed or delayed diagnoses

Our analysis showed GPs can be susceptible to missed or delayed diagnosis issues arising during any stage of care, from initial assessment, through testing, results management and follow-up. A thorough history and physical examination, appropriate and timely referrals, and effective use of follow-up and recall systems can help reduce your risk of a diagnosis-related complaint or claim.


Communication is a key risk management tool

Reports from Australian medical regulators consistently highlight communication issues as one of the top five underlying reasons for patient complaints. Almost every aspect of patient care involves communication, from obtaining history, to agreeing a care plan, or recommending and obtaining consent to treatment. If there is a problem with communication at any stage, there is a greater chance of an unexpected outcome or a complaint. Paying attention to communication with patients can help to reduce the likelihood of experiencing a claim or complaint.


Medication-related issues

Our analysis showed medication-related allegations are also fairly common for GPs, including prescribing drugs of dependence and other prescribing issues. When a medico-legal evaluation was conducted, these types of allegations were also more likely to fall below the expected standard of care compared to other types of matters. Specifically, 56% of matters relating to prescribing drugs of dependence did not meet the standard of care expected (compared to 37% for matters overall). See our analysis of opioid prescribing-related claims for more information, available at the Avant Learning Centre.


Resources

For more information on diagnosis, communicating with patients, prescribing issues and a wide range of other topics, visit the Avant Learning Centre where you will find articles, case studies, podcasts, webinars, videos, factsheets and many other resources.

If you receive a claim or complaint contact us on 1800 128 268 for expert medico-legal advice on how to respond – available 24/7 in emergencies.


Glossary

  • Claims refers to claims for money, compensation and civil claims.
  • Complaints relates to formal complaints to regulators.
  • Matters include; claims, complaints, coronial cases and other matters such as employment disputes and Medicare.
  • Employment disputes are matters where Avant defends members against complaints or supports members to resolve employment issues.

For any queries on this analysis, please contact us at research@avant.org.au

It is heartening to see that despite 1 in 10 Avant GPs having a complaint or claim raised against them over a one-year period, more than half of those were found to have met the standard of care. The elements of good clinical care and record keeping, help us to successfully defend GP matters.

Dr Penny Browne, Chief Medical Officer, Avant Mutual
 

IMPORTANT: Avant routinely codes information collected in the course of assisting member doctors in medico-legal matters into a standardised, deidentified dataset. This retrospective analysis was conducted using this dataset. The findings represent the experience of these doctors in the period of time specified, which may not reflect the experience of all doctors in Australia. This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision-making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published [July 2020]. © Avant Mutual Group Limited 2020.

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