We have heard all about accountable doctors. Here’s why patients must be held accountable.
“I saved you a voicemail,” my friend says over a hastily arranged lunch. After ordering, I hit play and listen not once but three times. The message is like a poorly microwaved meal: warm on the surface, stone cold inside.
The caller is the Australian Health Practitioner Regulation Agency, the authority that ensures the public can maintain trust in the medical profession.
In the message, a man politely conveys that a complaint against my friend is on the way. Acknowledging that this can be stressful news, he urges her to avoid stress although he doesn’t suggest how she might do so amid the mystery surrounding the notification.
She spends the night terrified. Unhappy and malcontent patients from 25 years of practice race through her mind. In the habit of apologising and fixing things, did she offend someone so grievously that it triggered a complaint?
The next morning, after a distracted drive, she sees patients she could not bear to cancel. When her inbox pings, she waits until the last patient has left. The email states that she is under review and gives her two weeks to respond. Adding insult to injury, she must list all her workplaces, so the public is shielded while she is investigated.
The complaint is surprisingly superficial. A patient has accused her of missing a diagnosis of chronic pain, correctly diagnosed 10 years later, and questions how she could have missed it.
My friend’s first reaction is that she cannot remember that patient. A search of her database reveals no such name, which instead of relief triggers dismay. Why should a patient go amiss? Was the database lying?
She drives home late at night, hungry and tired, tells no one and crawls into bed for the first of many disrupted nights’ sleep.
The next day she upturns archived records from the last decade. Still nothing.
Perplexed, she finally calls Ahpra, apologising that she doesn’t believe she knows the complainant.
The response is strange. A polite man says she could be right but for good measure, assuming it were her patient, she should explain to Ahpra how she would have managed his pain.
This suggestion makes a mockery of patient care. Chronic pain is as hard to bear as it is to treat, the treatments as abundant as the causes. How could a doctor blindly answer how she would treat a hypothetical patient?
Despite her eagerness to close the matter, she finds the advice so outlandish that she calls her medical insurer. Her lawyer drafts a curt response to Ahpra saying no thanks.
But then her expectation of a swift resolution is thwarted by an uncertain wait as the regulator and the Medical Board of Australia study the case.
Meanwhile, anxiety erodes her equanimity.
Why would someone target her? What if the regulator unearths some other wrong? Could she lose her licence? And if not her licence, then her reputation? If she loses her livelihood, who will pay the mortgage and school fees?
It is impossible to prevent the disillusionment from seeping into her attitude. She disengages from seemingly nice patients, wondering who else will complain. Having barely taken maternity leave and sacrificed many family occasions to serve the community, she kicks herself over a thankless job performed at personal cost.
But the best doctors only imagine caring less, they never really stop caring. By day, she fulfils her duty to patients, consistently overbooking and overworking. At night, she loses sleep and peace of mind.
Ahpra advises doctors under investigation to talk to their friends in the same boat but, sadly, they too have tales of woe.
Like the story about my cancer patient who repeatedly declined appointments. My pleas to see me (or someone else) were matched by her refusals. Then, she became incurably ill and complained that I had been negligent. My empathy collided with a proverbial slap in the face; the burden of proof fell on me.
Doctors fear that until they are exonerated there is no knowing how even the most baseless complaint will turn out. The only consolation I can give my suffering friend is that she is so good that other doctors choose to see her.
The power imbalance between doctors and patients, and the egregious harm that some patients suffer at the hands of a few doctors rightly means that all doctors should be held to a high standard of care. But it’s a broken system that holds doctors accountable but not their patients.
Ahpra says vexatious complaints account for less than 1% of notifications. Doctors challenge this, with a poll of 1,290 GPs showing that 80% believed they had been subjected to such a complaint.
Patients have registered complaints for being refused a script, disability certificate or medical leave and for being asked to wear a mask in the waiting room. Every complaint takes hours of paperwork and months of dread to refute.
Doctors worry that Ahpra’s vexatious notifications framework may not be working as it should.
Why this matters to society is that groundless complaints cause sufficient psychological harm to drive doctors away, leaving entire communities without sound medical care. Which is why complaints should be factchecked and triaged, complainants must be educated about their responsibility, and doctors should not be made to feel prematurely guilty.
After months of uncertainty, Ahpra tells my friend to relax, there is no case to answer because she had told the truth. She’d love to know what consequence the patient faced for making a seemingly unfounded accusation and how other doctors might be protected from her experience.
My friend absorbed the cost and the angst. But next time she might just quit, and we would be left lamenting that, when the complaints process is flawed, the patient wins nothing and the community loses a good doctor.
Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death
