The emotional impact of AHPRA complaints by patients
A single doctors narrative View. Published in Australian Doctor Magazine
My world fell apart' - doctor describes her blind fear when AHPRA came knocking
Melbourne doctor appeals for a more humane reporting process
16th August 2018
Special Report: Part 1
Each year up to 5,000 doctors will be subject to a formal complaint by a patient. But while relatively common, the emotional fallout is less discussed.
In this two part series Australian Doctor examines the impact on doctors' lives.
Below we publish the personal experience of a Melbourne doctor during a three month AHPRA investigation.
Tomorrow we look at the ways doctors survive complaints and the need to reform a system causing so much harm.
“I was in my doctor’s waiting room, scrolling through my emails, when one caught my attention.
Up until then, I had been having a pretty good day, but the moment I read the email’s title, blind panic set in.
The title read: SEC-CLASSIFIED. NOTIFICATION TO AHPRA.
I had no idea what the email was about or who had complained about me, but my worst fears included injuring a patient or in some way being responsible for harm.
My name was called out, and during the ensuing consult, I took in nothing and left, driving home to an empty house so I could read some more.
The identity of the patient shocked me because I had not seen them for some time and had no idea they were angry at me.
The nature of the complaint, which I won’t go into, also made no sense. There was a demand for me to be 'severely reprimanded' and my receptionist dismissed.
I fought off the urge to head back to my clinic on my afternoon off to trawl through their notes.
Instead, I called my medical defence organisation.
The ‘first responder’ for me was a colleague I had known for many years. I have great respect for him.
He is a staunch supporter of doctors’ wellbeing and was involved in the recent debates about self-harm and suicide in the profession.
His manner was caring — he asked me how I was and said he understood something of what I was going through.
The MDO was also very professional. They prepared properly, wanting me to get down to the hard facts of what happened.
They were being thorough, doing their job to protect me. I understand that. But at the same time I found it traumatising.
As we began the scramble to respond to the notification, those in my inner circle called and checked I was okay — which made a big difference.
My GP was sensational, as always. When they revealed they had been through a similar experience, I used it as a way of soothing myself.
I held my GP in high regard and if they had been complained about, then maybe (my thoughts went) I was okay as a doctor?
But the doubts came, even though I knew I had done nothing wrong. I began to fear my documentation had been substandard.
My MDO said this was untrue because the correspondence trail could prove unequivocally that the patient was not my patient at the time they claimed I had so dramatically failed them.
But I still found myself writing out copious notes based on my memory of our consults.
In my head I was thinking, ‘What would AHPRA say about this? Is it enough? Does it substantiate what really happened?’
I developed another behaviour that was also purely defensive.
I had not picked the patient who made the complaint.
Was I missing any others who might come after me? I closed my books immediately and have not taken on a new patient since.
In a strange way, if I had actually done something wrong I could have reflected on it and modified my practice. There could have been a resolution. But in the absence of a mistake, my imagination went into free-fall.
There were other implications for me.
At the time I was about to embark on a locum role in regional Australia.
I had been to this hospital before, and the hospital knew me well.
Despite that, a clause in my contract deemed I had to disclose if I was the subject of a ‘complaint’.
Nobody at the locum agency or the hospital could tell me whether this meant being subject to a notification or a formal investigation, so by default I had to divulge the fact that I was the subject of an AHPRA investigation.
I then had to wait 48 hours to see if the hospital deemed me safe. They did.
When I arrived at my locum role, I caught up with the nurses on the ward as usual.
I had plenty of corridor conversations that were quite healing, but one nurse in particular stood out.
I was shocked to hear she was leaving. She was extremely competent, and I had to ask why she would quit.
The nurse told me that after 15 years of nursing, she could pretty much handle anything — the ridiculous bed pressures, the incidents of violence, the revolving-door system for patients.
But she just couldn’t handle a patient’s recent complaint about her clinical care.
There is meant to be a dramatic narrative to stories like mine — one that justifies the massive anxiety, the phone calls, the meetings with lawyers, the faxing, scanning and emails, the desperate fear.
Something that justifies writing it down.
But there is no dramatic narrative because, after three months of this, nothing happened.
I’m sitting here writing this article after receiving AHPRA’s notification this morning.
The agency said that after looking into the complaint, there was no substance to it. It was all over.
There was no apology. And I guess the patient didn’t get what he wanted either. The end.
No, not really. I’m writing this because I need some clarity about why the patient’s complaint was so hurtful. I was blindsided.
I have over-thought this way too much, I know that.
But the thoughts need to go somewhere and, having spent too much time checking in with other doctors about my experience, I know that my reaction is not unique.
It is not just that you end up under the scrutiny of a regulator that holds the future of your livelihood in its hands — your medical registration. It also governs your very identity; you as a caring doctor, you as a caring human being.
And the way in which all that can be so quickly and brutally dismantled is fraught with danger and risk.
Talking about these experiences and how to get through to the other side — including when the complaint is dismissed and when the doctor has made a mistake and the complaint is upheld — is an area we, as a medical profession, are yet to fully embrace.
And yet, it must be a massive contributor to burnout, the unravelling of lives and families, and — in some cases — to doctor suicide.
I hope writing about my experience allows other doctors to understand their emotional response when they’re at the receiving end of a complaint.
I also hope that maybe AHPRA and the other regulators that circle around us gain some insight into how a person’s world is thrown upside down when they press send on those notifications.
I understand things go wrong in medicine.
But the process needs to be made more humane. Most people who have seen the way it works know it’s damaging too many lives.”
- This doctor asked to remain anonymous.