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.