Tessa Davis: Stress of complaints

EARLIER this year beyondblue conducted a national mental health survey of doctors and medical students. The results should be a wake-up call for all medical organisations.

Doctors have a higher reported rate of mental health problems than the general population and yet we are far less likely to seek medical help.

Those working in oncology are affected the most, with 33.9% having a minor psychiatric disorder and 5.5% experiencing very high psychological distress. Excessive alcohol use is also alarmingly prevalent, with 17.2% of emergency medicine doctors drinking at moderate risk levels.

Experiencing psychological distress must inevitably have an effect on patient care — it could lead to unprofessional behaviour and preventable errors.

The mental distress experienced by doctors can only be increased by the regulatory mechanism under which we operate. In that context it is interesting to see that the UK’s General Medical Council (GMC) has recently been under the spotlight for the pressure its complaints process puts on doctors.

Reports from the UK say the GMC has announced a review of its processes after revelations that since 2004, 96 doctors have died while being the subject of fitness-to-practise complaint proceedings.

There were concerns that a number of these deaths were due to suicide, with the GMC now conducting an internal inquiry into the handling of complaints.

The complaints process in the UK is very similar to the Australian Health Practitioner Regulation Agency (AHPRA) notification process.

An Australian study has also found that doctors experiencing a current medicolegal matter are at increased risk of psychiatric problems and hazardous alcohol use.

We all appreciate the day-to-day pressures of working in medicine, so imagine the additional stress for any doctor going through a complaints process (regardless of the final outcome). This must have an impact, not just on their current job, but on their career and their personal life.

Having invested so much time, money and effort into our training the fact that we could lose our career if we are subject to a complaint is frightening. So “confessing” to a problem may not seem like an option to junior doctors struggling with all our profession throws at them.

Doctors are under immense pressure in the workplace — hours worked, antisocial work times, variety of patients, fear of complaints and the stigma of “confessing” to errors.

When doctors do slip up, or are thought to be acting unprofessionally, the process of going through fitness-to-practise-style proceedings will take a further psychological toll.

More should be done. Some hospitals may be conscious of the need to offer support and guidance to doctors in these matters but the beyondblue results show that doctors are often reluctant to seek help. Perhaps it should be routine practice for every doctor to meet with a councillor once a month. That might help to overcome the stigma of talking about mental health problems.

AHPRA must release its statistics on deaths during the notification process, and we need further information from the GMC about how many of the 96 doctors’ deaths in the UK were from suicide, as this would indicate the scope of the problem.

All regulatory bodies must be acutely aware of the potential impact on the mental health of doctors during complaints proceedings. The tone, nature and frequency of communication need to be investigated; and there should be support in place for doctors during these times.

Doctors feel emotional and responsible when their patients die. We feel exhausted working night shifts and antisocial hours, and we feel pressure to project a good image to our patients and colleagues.

With this amount of stress, it is no wonder that doctors make mistakes.

Sometimes doctors do make mistakes that are more than simple human error. In these cases we must be held accountable to our regulatory authorities, and through them to the public.

But we are still human. Doctors should have support and guidance during our normal working week, but even more so during any complaints process.

Dr Tessa Davis is a paediatric emergency medicine trainee originally from Glasgow and now living in Sydney.