Receiving a complaint about your professional conduct can be a stressful and confronting experience. Here we outline the processes involved in dealing with a complaint from a complaints body about your professional conduct.

Most doctors regard a professional conduct complaint as a direct assault on their personal and professional integrity. Medico-legal matters can place practitioners and their families under a great deal of stress. Australian research has found that having a current medico-legal matter is one of the major work stressors in doctors, followed by not taking a holiday in the previous year and working long hours. It is nominated by many as one of the most major traumas in their life, whether or not the matter was ultimately resolved in their favour. 

It is important that you look after yourself during this process. Our medico-legal advisors can discuss the complaint with you and provide advice on how you should proceed.

What should I do if I receive a complaint? 

The first you may know of a patient complaint is when you receive a letter from either the Australian Health Practitioner Regulation Agency (AHPRA) or a health complaints entity (such as the Health Care Complaints Commission [HCCC] in NSW, or the Office of the Health Ombudsman [OHO] in Queensland). 

The letter will normally come with a copy of the complaint (or “notification”) enclosed. The complaint may have been made through a formal notification, by letter, email or even a telephone call. A complaint may be made by a patient, a hospital, a colleague or on referral from the coroner following a coronial inquest. 

At this early point in the process it is important to ensure you:

• DO NOT contact the patient or the person who has made the complaint. This could be interpreted as an attempt to dissuade that person from complaining or to encourage them to withdraw their complaint. Such a move could be considered inappropriate conduct
• DO NOT contact AHPRA or the complaints entity until you have sought advice from Avant – if emotions are running high, you could say something to the assessment officer that may hinder resolution of the complaint
• CALL AVANT – it is safer to share your feelings with us, and to seek our advice on how best to respond to the complaint 

Preliminary assessment 

Normally, the first stage in a professional conduct complaint is the assessment stage. Depending on the state or territory you are in, this usually involves consultation between the complaints-handling entity (e.g. AHPRA or the HCCC) and the Medical Board (or in New South Wales the Medical Council) to decide who is going to deal with the notification. If the Board deals with the notification then it must, within 60 days, carry out a preliminary assessment. In most states and territories, AHPRA assists with the preliminary assessment, although in New South Wales, the HCCC deals with the preliminary assessment and in Queensland, the OHO deals with the preliminary assessment. 

The Assessment Officer gathers the appropriate information to enable an assessment of the complaint. The Assessment Officer may:

• contact the complainant to clarify the notification 
• seek a response to the notification from the doctor 
• seek to obtain the patient’s health records to enable a clinical assessment of the care provided.

Preparing a response 

The Assessment Officer usually allows you 7-14 days (this time can vary) to provide a written response to the notification. Avant has been assisting doctors to prepare responses to complaints for many years and in our experience, a response that is professional, factual and that displays insight into the patient’s complaint is more likely to result in a good outcome for the doctor. 

If you require more time to make your written response it is best to contact Avant and we will seek an extension for you. 

An effective response usually contains the following elements:

• Acknowledgment of the notifier’s point of view. It is helpful to remember that the patient genuinely believed in their complaint and so an insightful, conciliatory response may assist in resolving their concerns. 
• Provision of factual information to address the issues raised. Where possible, your response should be supported by entries in the patient’s medical record. 
• Clarification or correction of misunderstandings. 
• An apology – either for the problem perceived by the patient, or sometimes (carefully) for an outcome referred to in the complaint. 
• A description of changes that you will make in your practice to avoid a similar set of circumstances, or at least an assurance that you have considered the notifier’s comments carefully. 
• A suggestion for an action that may resolve the patient’s complaint; e.g. “I will forward a copy of the records to Dr Y immediately” or “in hindsight, I recognise that while I am not prepared to sign the letter that Mr V has prepared, I could prepare a factual medical report for his solicitor”.

Ask Avant to review your response 

Before preparing your response you should consider who has made the complaint and whether you will be breaching a patient’s confidence in providing a response; your Avant Medico-Legal Advisor can guide you on this. Despite your best efforts it can be very difficult to maintain your objectivity in the face of a complaint about your professional care and therefore it is wise to allow us to review any response you have prepared before you provide it to AHPRA or the health complaints entity. Please try to provide your response to Avant as soon as possible. This gives time to review the response and discuss recommended amendments with you.

Possible outcomes of an assessment 

AHPRA or the complaints handling entity can take the following action in relation to a notification: 

• decide no further action is required 
• issue a caution 
• accept undertakings 
• impose conditions on your medical practice 
• proceed with an investigation 
• carry out a health or performance assessment 
• refer you to a panel or tribunal hearing. 

In our experience, the majority of notifications/complaints are closed with no further action. 

Sometimes AHPRA or the complaints entity may make recommendations about your medical practice. Our Risk Advisory Service can provide advice on implementing these recommendations.

For more information on performance or health assessments, see: 
http://www.avant.org.au/Health-and-wellbeing/HealthyKnowledge-and-Career/Understanding-the-Legal-Process/Impairment-and-board-health-assessments/ 
and 
http://www.avant.org.au/Health-and-wellbeing/HealthyKnowledge-and-Career/Understanding-the-Legal-Process/Performance-assessments/.

What happens if there is an investigation? 

If there are serious concerns arising from the complaint, the matter may be referred for investigation. This involves a peer review process, and may result in disciplinary action. This can be a time-consuming and extremely stressful process.

How to look after yourself 

At Avant, we aim to make this process as straightforward as we can for you. However we recognise that it can be extremely confronting to receive a complaint, and you should not underestimate how stressful this can be for you and your family, particularly if the complaint proceeds to an investigation. 

Your claims manager and lawyer are available to answer any questions you might have about your matter or the process involved. 

Disciplinary matters are time-consuming and can take months or even years to resolve. It is critical that you look after yourself, and your family, through the process of dealing with a claim. 

If you have been notified of a complaint, or have other medico-legal concerns you would like to discuss, please contact our Medico-legal Advisory Service.

Our wellbeing site provides tips on how to look after yourself during this process 

For confidential counselling contact Avant’s Personal Support Program on 1300 360 364. 

For more advice, call Avant’s Medico-legal Advisory Service on 1800 128 268. 

Visit avant.org.au/risk/iq for Avant Risk IQ resources including webinars, eLearning courses, case studies and checklists.