Compensation claims and complaints insights obstetrics & gynaecology

Compensation claims and complaints insights obstetrics & gynaecology

Summary:
What are the main issues driving gynaecology or obstetrics & gynaecology members' compensation claims and complaints? Find out the underlying themes and insights to reduce your risk of these types of claims and complaints, in our analysis.

Obstetrics & GynaecologyObstetrics & GynaecologyClaims insights
23 / 10 / 2019

One in six Avant gynaecology or obstetrics & gynaecology members (O&G) had a claim for compensation, complaint to a regulator, coronial inquiry or another matter raised about the provision of their care in FY2017-18. Doctors can sometimes have allegations made against them even though they provided appropriate care.

The types of matters Avant assists O&G members with include*:

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Our medico-legal data

Members asked us for more information about medico-legal matters such as, claims for compensation and complaints to regulators. In response we conducted a retrospective review of routinely collected and coded data. The following is based on nearly 400 matters involving Avant gynaecology or O&G members from across Australia, indemnified and finalised over the four-year period from July 2014 to June 2018.

These insights may help you better understand and manage your medico-legal risks, and optimise the quality and safety of your care.

Common claims and complaints

The majority of medico-legal matters were claims for compensation and regulatory complaints. These related to:

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Gynaecological procedures

33% of claims and complaints were related to gynaecological procedures. The stage of care during which these occurred:

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Obstetrics management

25% of claims and complaints were related to obstetrics management. The stage of care during which these occurred:

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Practitioner behaviours

Allegations relating to practitioner behaviours included communication issues (6%), boundary transgression (3%) and advertising (2%).

Resolution of matters

When a medico-legal evaluation of expected standards of care was conducted, the doctor was considered to have met the standard in 67% of cases. Regardless, these cases can still take many years to resolve.

Key insights and implications for practice

Our data highlights that claims and complaints against O&Gs are common, and it is not surprising the majority are related to surgical procedures and obstetrics management.

We also identified other issues that can give rise to claims and complaints such as communication. In our experience, paying attention to how you communicate with patients can help reduce the likelihood of experiencing a claim or complaint.

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. Our data also suggests, that while complaints primarily about communication are relatively infrequent, shortcomings in communication underlie a significant number of claims and complaints.

Almost every aspect of patient care involves communication, from obtaining history, to agreeing on a care plan, or recommending and obtaining consent to treatment. If something goes wrong, if patients feel they have been left in the dark, they were not listened to, or their concerns were dismissed, they are more likely to complain or take legal action than if their doctor is a good communicator.

Even with the most skilled care, patients may be unhappy with an outcome if they have not understood the limitations of a procedure, or the potential post-operative implications, considering their own circumstances. In these cases it’s not uncommon for patients to believe that the procedure was performed poorly. This mismatch of expectations may explain why our data shows that in two-thirds of matters, where a medico-legal evaluation is conducted, the assessment found that the doctor met the expected standard of care.

Providing information and developing care plans

In both obstetrics and gynaecology, communication is key to building trust and developing an effective ongoing relationship. While there are some obvious differences in discussing an obstetric care plan, screening test or alternative treatment options, there is also a common thread. Listening to the patient’s perspective and communicating that you have heard and understood what is important to them are essential, whatever type of care is being discussed.

  1. Consider the proposed plan and options from the patient’s perspective, by exploring what is most important to them.
  2. Explain the alternatives, including the option of not undertaking any procedure or test you may be suggesting.
  3. Discuss the range of outcomes the patient can expect and give the patient context. Discuss what a common outcome or complication would mean to them, and how they can be managed.
  4. Advise the patient of known risks of a procedure, based on the patient’s situation, regardless of whether you have experienced these complications in your practice.
  5. Ask the patient which risks, if any, particularly concern them, and whether they have any concerns which have not been mentioned.
  6. Advise the patient of alternative contact arrangements in the event that you are unavailable, pre or post procedure.
  7. Test the patient’s understanding by asking them to repeat in their own words what you discussed.
  8. Use tools such as diagrams or models to complement your discussions. Use relevant written supporting material, such as those developed by your college. Offer a copy to the patient and keep a copy or note in the patient’s record.
  9. Make sure the patient has time to absorb the information, reflect and come back with any further questions.
  10. Document your discussions carefully. If possible, also note that they have read the supporting materials and had an opportunity to ask questions.

Useful resources

If you receive a claim or complaint contact our Medico-legal Advisory Service on 1800 128 268 for expert advice on how to respond, available 24/7 in emergencies.

Read our articles, factsheets, case studies and other resources on a range of topics available at the Avant Learning Centre - avant.org.au/avant-learning-centre/

For any queries please contact us at research@avant.org.au

"We have come to believe that our medical knowledge and surgical skills represent the value proposition in professional care. These things can be taught. Patients judge us by their perception of our competence, but their acceptance of the outcomes of medical care is entirely based upon our understanding of their expectations, effective communication and our recognition of the need to personalise our provision of information in a way that is respectful of that particular individual’s needs."

– Dr Vijay Roach, President of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG)

IMPORTANT: Avant routinely codes information collected in the course of assisting member doctors in medico-legal matters into a standardised, deidentifed dataset. This retrospective analysis was conducted using this dataset. The fndings represent the experience of these doctors in the period of time specifed, which may not refect the experience of all doctors in Australia. This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision-making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss sufered in connection with the use of this information. Information is only current at the date initially published (July 2019).

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