Who’s most likely to complain and how to stop them. (Spoilers: dunno.)
Wouldn’t it be great if you could profile the type of patient most likely to pitch you headlong into an AHPRA notification vortex and identify the best way to stop that happening?
It would certainly be great for mega-medical insurer Avant, which is why it commissioned a rapid review of the evidence from the Sax Institute in the hope of answering two questions:
1: What are the common characteristics and circumstances of patients who are most likely to complain or bring a claim about the care they have received from a doctor?
2: What initiatives or interventions have been shown to be effective at reducing complaints about the care patients have received from a doctor?
Unfortunately, the research institute came back with a big old shrug, thanks to the terrible quality of most of the evidence.
While there’s no shortage of peer-reviewed studies into the traits of medical practitioners most likely to get into trouble, there’s not many about the equivalent patient characteristics, and few of those really earn the name “study”: out of 25 papers the Sax team found that looked at “any correlation between the setting, type of care and patient characteristics and the type of complaint or nature of complaint”, only four included a comparison group.
For the second question they found only 20 papers, and likewise the vast majority of those were what the NHMRC politely classifies as “other” in its study quality hierarchy, wallowing somewhere below case series.
Out of 40 patient variables studied, 14 featured in more than one paper, including age, sex, race, employment status, insurance status, marital status and whether they had a mental, behavioural or neurodevelopmental disorder.
Age was weakly correlated with greater likelihood of complaint. So was being female – yes, Karen has entered the chat – but that association didn’t reach significance.
Using general anaesthesia on a patient also meant fewer complaints. You can make your own joke here.
Some studies looked at who was more likely to complain, the patient themselves or a relative/carer, but the results were conflicting.
The second part of the review found papers on seven types of intervention: risk management program, communication and resolution program, peer program, CPD participation, medical remediation program, shared decision-making and simulation training.
Unsurprisingly given the nature of the studies – nearly all uncontrolled before-and-after write-ups of small-scale programs – the results are basically all positive. If anyone took the time to do an intervention and write it up, you know they got good results.
Risk management programs were consistently reported to reduce claims and complaints, but again the studies had no control group and most were implemented in just one centre. Same story with communication and resolution.
You can almost the Sax people’s teeth grinding over the “uniformly weak” study designs, which are “highly prone to bias, lack control groups and statistical adjustment for confounders, have low sample sizes and/or are set in a single institution, and lack evidence about program fidelity and sustainability”.
In short, according to the evidence, no type of patient is more likely to complain except maayyybe older people, and anything you try will look like it made some complaints go away.
Sending story tips to penny@medicalrepublic.com.au is a powerful spell to ward off AHPRA notifications.
