Colleagues are best source of support for doctors facing complaints, researchers findBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5420 (Published 22 November 2017) Cite this as: BMJ 2017;359:j5420
Doctors facing a complaint have lower levels of depression and anxiety if they seek support from their colleagues, research published in BMJ Open has shown.1
UK and Belgian researchers concluded that denying doctors the chance to speak to colleagues, as may happen in serious cases, is “unreasonable,” as having the support of colleagues as well as management “was associated with less avoidance and psychological morbidity.” “Avoidance” can include avoiding some procedures, not accepting high risk patients, and abandoning procedures early.
The researchers sent an online survey to 95 636 BMA members to find out whether depression, anxiety, and defensive practice were associated with the support that doctors sought during complaints processes. They received 7926 responses (an 8.3% response rate), including 6144 from doctors who had faced a complaint.
The researchers found that most doctors (61%) who had faced a complaint felt supported by colleagues, while only 31% felt supported by management. And the doctors who spoke to colleagues about the complaint against them had the lowest risk ratios for depression and anxiety, they found.
Depression and anxiety were more common in doctors who reported speaking to family or friends about their complaint, doctors who engaged independent legal advice, and those who accessed support from the BMA’s employment advice service or a BMA counselling service.
The study authors wrote, “When doctors reported that they spoke to colleagues, they were significantly less likely to suffer from anxiety and depression, although it must be acknowledged that it is possible that doctors who are more anxious inherently find it more difficult to speak to colleagues.”
The survey also found that most doctors (78%) thought that the complaints process had been needlessly protracted. Nearly half (49%) of respondents said that the system had been used inappropriately or vexatiously, and 32% said that managers had used a complaint to undermine them.
Just under a quarter (24%) of respondents thought that a colleague had used a complaint to take advantage of them, either financially or professionally.
The researchers also found that around half of the respondents (54%) had never displayed avoidance behaviour and that 16% had never displayed “hedging” behaviour, which includes performing more tests than necessary, over-referral, and overprescribing.
Hedging was greatest when doctors spoke to family or friends and when they accessed help from medical professional support organisations, the researchers said.
They wrote, “No clear relationships were found between perceived support and hedging. Generally, process-related issues were not strongly associated with hedging, although a protracted timescale for a complaints process was a factor.”