Avant - Mutual Group

  • Dealing with the stress of a claim or complaint

    Facing a complaint, litigation or a disciplinary hearing is one of the most stressful events a doctor will face and it carries significant professional and personal impacts. Research looking at the psychological wellbeing of doctors (undertaken by psychiatrist Dr Louise Nash from the NSW Institute of Psychiatry) has shown that many doctors describe having a medico-legal complaint as the most traumatic experience in their lives, even when the matter is resolved in their favour.1

    With the number of complaints to regulators increasing2, more and more practitioners must deal with at least one at some stage during their career.

    While most doctors would prefer not to contemplate this experience, many of the strategies for dealing with a complaint are the ones that also assist in dealing with other stressful events.

    It can be difficult to recognise or build the support structures you need when you are already stressed. If you can put in place some support, before you need it, this may make a world of difference to you during challenging times.

    The impact

    Having your professional competence and reputation questioned can be extremely confronting, and the physical and emotional impact can be significant.

    Generally, practitioners facing some kind of complaint or claim are at a heightened risk of both physical and mental illness.3

    They are also at greater risk of making mistakes. Even if you think you are fine, it is important to remain aware of your wellbeing and your needs during this time.

    Legal processes are often lengthy and frustrating, and it can be easy to catastrophise over the possible outcomes. One of the toughest elements can be the feeling of loss of control over the process or the outcome. This presents a real challenge for doctors who are used to a high degree of professional autonomy.

    Practical strategies

    One strategy to take back some sense of control is to focus on what you can influence and proactively consider where you want to direct your energy.

    When you contact your medical defence organisation, they will often ask you to start putting down in writing your version of events. Many doctors have said they find getting the issue out of their head and onto the page a good way to feel as if they are doing something to get the process of resolving the complaint underway.

    It can also be helpful to think about other practical steps you might need to take in your practice. For example, consider whether you need to make changes to your practice to minimise the risk of mistakes during times of stress or distraction. Could you put in place a plan that would allow you to reduce your workload or take leave if you need to deal with other issues?

    Recognising strategies that work for you

    Consider how you tend to respond to stress. Have you found any coping mechanisms that have helped you manage stressful experiences in the past?

    Whatever these are, whether exercise, spending time with friends, walking or finding a quiet space to recharge, it can be easy to let these go in periods of stress. Since these are times when we need them the most, it is really important to try and make the space and time for them.

    Avoiding isolation

    We always ask what support doctors are getting in relation to the complaint, and it is sadly not uncommon to hear that they have told no-one. It is important not to isolate yourself completely.

    Research suggests that doctors who feel supported by their colleagues are best able to manage the stresses of the complaints process4. If you can talk to a colleague or mentor you may be surprised to hear they’ve been through something similar.

    It can be helpful to talk about how you feel with those close to you, even if you cannot share specifics due to confidentiality.

    Sharing the emotional impact can help lessen the burden and make the process less daunting. It can also help family and friends understand what is going on if the strain does show at home.

    Finding the help you need

    In an article published in Avant’s Connect magazine5, psychiatrist Dr Kym Jenkins points to the importance of thinking ahead as a strategy for managing all kinds of professional and life stresses.

    Dr Jenkins suggests thinking about where you would go for assistance for all kinds of issues, from having the flu to a family crisis, to needing a professional sounding board, being involved in a workplace dispute or receiving a complaint.

    Do you know who to talk to, or how to access support networks?

    Key contacts

    If you do receive a complaint, don’t try to deal with it alone.

    There are many support resources available, both personal and professional.

    For medico-legal advice and support, contact Avant at nca@avant.org.au or on 1800 128 268, 24/7 in emergencies.

    We can also put you in touch with external supports such as the Doctors’ Health Advisory Services.

    This article was originally published in the Australasian Gynaecological Endoscopy & Surgery Society escope newsletter in July 2019.

    Cautionary Tale

    Member Story

     

    Keeping well while facing a medico-legal complaint - a personal story

    Dr Emmanuel Varipatis, a 59-year-old GP from Manly, NSW, was sued for $350,000 after a judge found that he had been negligent in not referring a morbidly obese patient for gastric band surgery. Here, he explains what self-care measures he employed throughout the ordeal.

    The story begins

    It was just a normal day. I was standing at reception and picking up a file when I got served. I opened the envelope and saw it was a Supreme Court document; I was being sued by a patient who I thought I’d looked after quite well for a long time and who I’d gone out of my way to take care of.

    Stress symptoms

    I found that my mind was obsessing on the case 24/7 and it was too easy to let this take over. I started suffering the basic symptoms of anxiety with even occasional moments of panic, and found myself waking up in the middle of the night with the case on my mind. When it became evident that this case wasn’t going away, I decided I needed a strategy to deal with it so it wouldn’t affect my work, family life or health. To achieve this, I needed a plan to manage my cortisol levels as best I could.

    A plan of action

    I followed my own advice and engaged in the same type of stress management techniques that I would recommend to my patients. The first thing I decided to do was to change my attitude around this case. It was self-evident that worrying and obsessing wasn’t going to change anything; so I made a deliberate decision that, as much as I could, I would stop worrying and just take whatever actions were necessary, as necessary.

    Relationships and lifestyle

    I kept my wife involved and found that being able to ‘share’ the stresses made it easier for both of us. I made sure to keep up a nutritious diet and stuck to the rule of ‘early to bed, and enough sleep’.

    Full steam ahead

    I increased my exercise from two hours to five hours a week with sessions of Pilates, walking and body surfing. I did lots of early morning walking sessions with mates around the headlands, followed by outdoor gym exercising, then body surfing and finally breakfast. This combination of social ‘guy time’ plus exercise was probably the best help of all in keeping me sane.

    Meditation

    I restarted the regular practice of meditation. I find it easier to do if it’s ‘directed’, so would generally use phone apps that allow me to just put on headphones and listen to guided meditation and self-hypnosis sessions.

    A set back with health implications

    When the judge found against me, the case received nationwide media coverage and I received lots of unwanted publicity. So even though I still felt I was coping well; it was at this point that my blood pressure went up and I had to commence medication for it.

    It has proven to be a high-publicity case with unusual longevity; a marathon case that just keeps on going. As life stressors go, this case for me has ended up rating right up there with bad marital or financial stress; and I am certain that I would be ‘a mess’ now if I hadn’t worked out an action plan early on for managing the stress of this case.

    A good outcome

    The Court of Appeal found in favour of Dr Varipatis, overturning the NSW Supreme Court’s earlier decision. The High Court of Australia has subsequently rejected the patient’s application for special leave to appeal the Court of Appeal’s decision, effectively closing the door to further appeal and bringing this stressful event to its conclusion.


    References

    1Nash L, Tennant C, Walton L. The psychological impact of complaints and negligence suits on doctors.

    2Australian Health Practitioner Regulation Agency. Annual Reports from 2010/11-2018/19.

    3Avant. The impact of claims and complaints on doctors’ health and wellbeing.

    4Bourne T, De Cock B, Wynants L, et al. Doctors’ perception of support and the processes involved in complaints investigations and how these relate to welfare and defensive practice: a cross-sectional study of the UK physicians.

    5Jenkins K. ‘Plan ahead to look after yourself’, Avant, Connect magazine, issue no 6, p. 5.

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