Claims and complaints insights: General practitioners

On average*, every year one in 10 Avant general practitioner (GP) members had a matter raised about the provision of their care.

Allegations are sometimes made against doctors even when they provided appropriate care.

Types of claims and complaints indemnified:

Types of compensation claims and regulatory complaints:

Breakdown of claims and complaints

22% related to practitioner behaviour

42% of these were about interpersonal issues with patients such as poor communication of results or information, inappropriate comments, poor manner, lack of empathy or being brusque, rude or intimidating.

Another 20% were about boundary transgressions including those of a sexual nature, treating family or close friends, inappropriate examinations and inappropriate manner or behaviour of a non-sexual nature.

21% related to medication

48% of these were about prescribing drugs of dependence including inappropriate prescribing, over-prescribing and inappropriate refusal, cessation or dose reduction.

21% related to diagnosis

75% of these were about a missed or delayed diagnosis, mostly during the initial assessment. This may have been because of an inadequate examination, not referring for appropriate diagnostic testing or not heeding patient complaints or symptoms.

Standard of care outcomes for GPs

When a medico-legal evaluation of expected standards of care was conducted, the doctor was considered to have met the standard in nearly two thirds of cases.

This retrospective review is of routinely collected and coded data. Our review is based on more than 5,800 compensation claims and regulatory complaints involving Avant GP members across Australia. All claims and complaints were closed over the five-year period from July 2017 to June 2022.

Key points

• GPs are more likely to be subject to a regulatory complaint, rather than be sued for compensation.
• The most common types of claims and complaints were related to practitioner behaviours, medication and diagnosis.
• In almost two-thirds of cases the GP was considered to have met the standard of care and the outcome was favourable for the GP.

Communication is a key risk management tool

Reports from Australian medical regulators consistently highlight communication issues as one of the top five underlying reasons for patient complaints. Almost every aspect of patient care involves communication, from obtaining history, to agreeing a care plan, or recommending and obtaining consent to treatment. If there is a problem with communication at any stage, there is a greater chance of unmet expectations or a complaint. Paying attention to communication with patients can help to reduce the likelihood of experiencing a claim or complaint. See our analysis of doctor–patient communication-related claims available at the Avant Learning Centre.

Medication-related issues

Medication-related allegations are common for GPs, especially regarding prescribing drugs of dependence. Our medico-legal evaluation found these were more likely to fall below the expected standard of care compared to other types of matters. See our analysis of opioid prescribing-related claims available at the Avant Learning Centre.

Missed or delayed diagnoses

GPs can be susceptible to missed or delayed diagnosis issues during any stage of care butthey are most common during initial assessment. A thorough history and physical examination, appropriate and timely referrals, and effective use of follow-up and recall systems can help reduce the risk of a diagnosis-related complaint or claim.

Glossary

• Claims refer to claims for money, compensation and civil claims.
• Regulatory complaints relate to formal complaints to regulators such as Ahpra.
• Medicare matters include Medicare investigations and audits.
• Employment disputes are matters where Avant defends members against complaints or supports members to resolve employment issues.
• Matters include; claims, complaints, coronial cases and other matters such as employment disputes and Medicare.

Medico-legal advice

If you receive a claim or complaint, contact us (avant.org.au/MLAS) on 1800 128 268 for expert medico-legal advice on how to respond – available 24/7 in emergencies.

For any queries on this analysis, please contact us at research@avant.org.au

For more information on communicating with patients, including advice about obtaining consent and a wide range of other topics, visit the Avant Learning Centre, where you will find articles, case studies, podcasts, webinars, videos, factsheets and many other resources.