Intended for healthcare professionals


Doctors are emotionally “damaged” by complaints, analysis finds

BMJ 2016; 354 doi: (Published 05 July 2016) Cite this as: BMJ 2016;354:i3732
  1. Matthew Limb, freelance journalist
  1. BMJ Careers
  1. limb{at}

Doctors who face complaints are being left emotionally “damaged” by the experience in ways that may harm patient care, a new analysis has said.

The study uncovered the feelings that doctors have about complaints processes, the impact on their psychological wellbeing, and “defensive” practice. Doctors said that they felt powerless, incompetent, and unsupported in a system that was “biased” against them and offered few positive outcomes.

The researchers behind the study said that around a quarter of doctors reported that a complaint had led to changes in their practice. Some considered a change in career while others “practised more defensively,” such as overprescribing medicines as a precaution or not taking on difficult cases.

The researchers said that the findings showed that “toxic” complaints procedures should be reformed because they provoked fear and anxiety rather than creating fair and open opportunities for learning.

“What’s going on here is against natural justice and it is not good for patients,” Tom Bourne, study co-author and a professor at Imperial College, London, told BMJ Careers. “The system needs to be reviewed—so that we get away from doctors being fearful when things go wrong—and turned into a learning environment.”

The analysis by academics from Imperial College and the University of Leuven in Belgium was published in BMJ Open.1 It expands on previous research by Bourne and colleagues into complaints against doctors.2

That earlier quantitative study, published in 2015, surveyed nearly 8000 doctors about the impact of complaints procedures on their welfare, health, and clinical practice. The study found that doctors with recent or current complaints had significant risks of moderate to severe depression, anxiety, and suicidal thoughts. It also found that most doctors reported practising defensively, including avoiding treating high risk patients.

The latest qualitative study analysed data from the second part of the survey, where doctors answered open ended questions and were free to write what they wished. It analysed responses from 6000 doctors who had experienced a complaint.

Most complaints were from patients although some were from colleagues. Most were dealt with internally by the doctor’s hospital or clinic, although some were referred to the General Medical Council.

Doctors were asked how the process made them feel, to describe its most stressful aspects, and say how it could be improved. Their answers were coded to reflect themes and analysis was done on a randomly selected representative sample of 100 doctors.

Nearly half (48%) had negative feelings towards the complainant or those managing the complaint. Most commonly this meant they felt that the complaint was “unfair” (31%). Around 45% said they felt impotent, powerless, or helpless, and 42% reported experiencing emotional distress. One said, “I cry, can’t sleep, and contemplate suicide and not being a doctor anymore.”

While 23% of the sample reported positive feelings towards some aspects of the experience, such as being supported, 22% expressed negative feelings towards themselves with 11% reporting feelings of failure or incompetence.

A majority (60%) said that procedural issues were the most stressful part of a complaint. There was a feeling that the process was “biased” in favour of the patient, with many saying that investigations took too long or were “unpredictable” in nature.

Bourne said that both studies showed that the complaints process was associated with “very significant effects on psychological health among doctors.” He said that the number of patient complaints against doctors had risen in recent years—with complaints against GPs doubling between 2007 and 2012.

Many respondents wanted procedures to be made more transparent, neutral, and time efficient (44%). Many said that there should be more open dialogue between doctors and patients rather than information being passed on through managers, and that doctors should receive emotional support.

Nearly a third said that there was a “need for a policy for vexatious, baseless, or unnecessary complaints.” Some said that patients or colleagues should be reprimanded if a complaint was found to be unfounded or malicious.

Bourne said that—in cases where the outcome of the complaint investigation was known—the vast majority of doctors were “exonerated” and yet had undergone a process that caused distress. “There shouldn’t be fear. Fear is toxic,” he told BMJ Careers. “If doctors are scared of procedures such as this, then if anything goes wrong they’re unlikely to be as open.”

He acknowledged that there were moves towards ensuring more support was given to doctors who were deemed vulnerable going into complaints procedures. But he said, “The point is that all doctors are vulnerable in relation to complaints procedures and the procedures need to reflect that.” He said that complaints procedures should be robust, with fixed timescales and “complete transparency about what’s being said and by whom.”