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What type of patients are most likely to complain?

Georgie Haysom, BSc, LLB (Hons) LLM (Bioethics), GAICD, Head of Research, Education and Advocacy, Avant

Dr Michael Wright, MBBS, MSc, PhD, FRACGP, GAICD, General Practitioner and Chief Medical Officer, Avant

Tuesday, 18 April 2023

Patients at practice counter

Do you ever wonder which patients might be more likely to complain? It’s human nature to form an early opinion on someone soon after meeting them, but wouldn’t it be helpful if you could identify someone more likely to complain about your care?

We recently commissioned research to look at this question and to understand how we might reduce the risk of subsequent claims. The results suggest that picking patients who may complain may be difficult, highlighting the importance of not pre-judging patients.

There is a large body of research looking at the relationship between a doctor’s characteristics and the complaints and claims against them, and literature on what patients want from their health care experience. However, it is less clear what, if any, patient characteristics and circumstances are associated with complaints and claims, so we explored the literature on this topic, published in the last decade. The research also looked at the effectiveness of risk management programs and interventions on reducing rates of claims and complaints.

Characteristics assessed

Overall the quality of the evidence in the literature was poor when judged against National Health and Medical Research standards. Despite this, there were 18 patient characteristics reported in the literature. The characteristics included age, sex, race, employment status, along with patient risk factors including previous (medical history) and therapeutic context (hospital versus community care, whether there were complications).

Generally, there was a lack of evidence and studies to support a link between any of these patient factors and the likelihood of making a complaint or claim. Although the studies suggested higher patient age (within a given patient population) may be weakly correlated with a greater chance of a complaint, patient age differed significantly depending on the patient population in the study. One study showed patients with an underlying mental health condition are associated with higher rates of patient complaints.

The overall finding is that none of the 18 patient characteristics demonstrated either strength or consistency of effect. Given the quality of this evidence it is difficult to draw conclusions. However, it does seem that patient features are not useful in predicting patient complaints. One potential reason could be because many complaints originate from people other than the patient.

Reducing the chance of a complaint

There is consistent but weak evidence that the seven interventions below reduce the number of claims and complaints, although the review found it’s not possible to state which of these is most effective.

  • Risk management programs - primarily educational but distinct from CPD.
  • Communication and resolution programs to better investigate and explain what happened after an adverse event.
  • Peer programs involving the provision of feedback to doctors.
  • CPD participation.
  • Medical remediation programs where poor performance is ‘remedied,’ and the doctor is permitted to return to safe practice.
  • Shared decision-making involving a patient and health care provider working together to agree on treatment options.
  • Simulation training focusing on team training and crisis management.

There is a real need for further research on both research questions, to fill the gaps identified in the report. Avant will be considering further research to understand more about the demographic and experiential characteristics of patients who make complaints and claims, and what interventions are most effective to help reduce them.

Avant is committed to helping you develop and maintain good relationships with patients across a variety of common situations. Visit the Avant Learning Centre to access our many patient communication resources.

Read the study

For full details of the study brokered by Sax Institute and conducted by a team from Flinders University, click here.

Austin EE et al., Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance. BMJ Open. 2021;11(8):e050377. doi: 10.1136/bmjopen-2021-050377.

See for example Rapport F et al., What do patients really want? An in-depth examination of patient experience in four Australian hospitals BMC Health Sciences Research 2019; 19(38) https://doi.org/10.1186/s12913-019-3881-z

National Health and Medical Research Council (2009) NHMRC levels of evidence and grades for recommendations for guideline developers. Canberra: National Health and Medical Research Council. Available from: https://www.nhmrc.gov.au/sites/default/files/images/NHMRC Levels and Grades (2009).pdf

Disclaimers


IMPORTANT:
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 suffered in connection with the use of this information. Information is only current at the date initially published.

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