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      Characteristics of complaints resulting in disciplinary actions against Danish GPs

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          Abstract

          Objective

          The risk of being disciplined in connection with a complaint case causes distress to most general practitioners. The present study examined the characteristics of complaint cases resulting in disciplinary action.

          Material and methods

          The Danish Patients’ Complaints Board's decisions concerning general practice in 2007 were examined. Information on the motives for complaining, as well as patient and general practitioner characteristics, was extracted and the association with case outcome (disciplinary or no disciplinary action) was analysed. Variables included complaint motives, patient gender and age, urgency of illness, cancer diagnosis, healthcare settings (daytime or out-of-hours services), and general practitioner gender and professional seniority.

          Results

          Cases where the complaint motives involved a wish for placement of responsibility (OR = 2.35, p = 0.01) or a wish for a review of the general practitioner's competence (OR = 1.95, p = 0.02) were associated with increased odds of the general practitioner being disciplined. The odds of discipline decreased when the complaint was motivated by a feeling of being devalued (OR = 0.39, p = 0.02) or a request for an explanation (OR = 0.46, p = 0.01). With regard to patient and general practitioner characteristics, higher general practitioner professional seniority was associated with increased odds of discipline (OR = 1.97 per 20 additional years of professional seniority, p = 0.01). None of the other characteristics was statistically significantly associated with discipline in the multiple logistic regression model.

          Conclusion

          Complaint motives and professional seniority were associated with decision outcomes. Further research is needed on the impact of professional seniority on performance.

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          Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities.

          André Jacques, Ilona Bartman, Roxane du Berger … (2007)
          Poor patient-physician communication increases the risk of patient complaints and malpractice claims. To address this problem, licensure assessment has been reformed in Canada and the United States, including a national standardized assessment of patient-physician communication and clinical history taking and examination skills. To assess whether patient-physician communication examination scores in the clinical skills examination predicted future complaints in medical practice. Cohort study of all 3424 physicians taking the Medical Council of Canada clinical skills examination between 1993 and 1996 who were licensed to practice in Ontario and/or Quebec. Participants were followed up until 2005, including the first 2 to 12 years of practice. Patient complaints against study physicians that were filed with medical regulatory authorities in Ontario or Quebec and retained after investigation. Multivariate Poisson regression was used to estimate the relationship between complaint rate and scores on the clinical skills examination and traditional written examination. Scores are based on a standardized mean (SD) of 500 (100). Overall, 1116 complaints were filed for 3424 physicians, and 696 complaints were retained after investigation. Of the physicians, 17.1% had at least 1 retained complaint, of which 81.9% were for communication or quality-of-care problems. Patient-physician communication scores for study physicians ranged from 31 to 723 (mean [SD], 510.9 [91.1]). A 2-SD decrease in communication score was associated with 1.17 more retained complaints per 100 physicians per year (relative risk [RR], 1.38; 95% confidence interval [CI], 1.18-1.61) and 1.20 more communication complaints per 100 practice-years (RR, 1.43; 95% CI, 1.15-1.77). After adjusting for the predictive ability of the clinical decision-making score in the traditional written examination, the patient-physician communication score in the clinical skills examination remained significantly predictive of retained complaints (likelihood ratio test, P < .001), with scores in the bottom quartile explaining an additional 9.2% (95% CI, 4.7%-13.1%) of complaints. Scores achieved in patient-physician communication and clinical decision making on a national licensing examination predicted complaints to medical regulatory authorities.
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            Characteristics associated with physician discipline: a case-control study.

            Matthew Fox, Neal Kohatsu, Margaret Ross … (2004)
            There has been increasing attention devoted to patient safety. However, the focus has been on system improvements rather than individual physician performance issues. The purpose of this study was to determine if there is an association between certain physician characteristics and the likelihood of medical board-imposed discipline. Unmatched, case-control study of 890 physicians disciplined by the Medical Board of California between July 1, 1998, and June 30, 2001, compared with 2981 randomly selected, nondisciplined controls. Odds ratios (ORs) were calculated for physician discipline with respect to age, sex, board certification, international medical school education, and specialty. Male sex (OR, 2.76; P<.001), lack of board certification (OR, 2.22; P<.001), increasing age (OR, 1.64; P<.001), and international medical school education (OR, 1.36; P<.001) were associated with an elevated risk for disciplinary action that included license revocation, practice suspension, probation, and public reprimand. The following specialties had an increased risk for discipline compared with internal medicine: family practice (OR, 1.68; P =.002); general practice (OR, 1.97, P =.001); obstetrics and gynecology (OR, 2.25; P<.001); and psychiatry (OR, 1.87; P<.001). Physicians in pediatrics (OR, 0.62; P =.001) and radiology (OR, 0.36; P<.001) were less likely to receive discipline compared with those in internal medicine. Certain physician characteristics and medical specialties are associated with an increased likelihood of discipline.
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              Physicians disciplined by a state medical board.

              Liam J. Morrison, P Wickersham (1998)
              State medical boards discipline several thousand physicians each year. Although certain subgroups, such as those disciplined for malpractice, substance use, or sexual abuse, have been studied, little is known about disciplined physicians as a group. To assess the offenses, contributing factors, and type of discipline of a consecutive series of disciplined physicians. Case-control study on publicly available data matching 375 disciplined physicians with 2 groups of control physicians, one matched solely by locale, and a second matched for sex, type of practice, and locale. All disciplined physicians publicly reported by the Medical Board of California from October 1995 through April 1997. Characteristics of disciplined physicians, offenses leading to discipline, and type of discipline. A total of 375 physicians licensed by the Medical Board of California (approximately 0.24% per year) were disciplined for 465 offenses. The most frequent causes for discipline were negligence or incompetence (34%), abuse of alcohol or other drugs (14%), inappropriate prescribing practices (11%), inappropriate contact with patients (10%), and fraud (9%). Discipline imposed was revocation of medical license (21%), actual suspension of license (13%), stayed suspension of license (45%), and reprimand (21%). Type of offense was significantly associated with severity of discipline (P=.03). In logistic regression models comparing disciplined physicians with controls matched by locale, board discipline was significantly associated with physicians' sex (odds ratio [OR] for women, 0.44; 95% confidence interval [CI], 0.28-0.70) and involvement in direct patient care (OR, 2.56; 95% CI, 1.75-3.75). In the regression model with additional matching criteria, disciplinary action was negatively associated with specialty board certification (OR, 0.42; 95% CI, 0.29-0.60) and positively associated with being in practice more than 20 years (OR, 2.02; 95% CI, 1.39-2.92). A small but substantial proportion of physicians is disciplined each year for a variety of offenses. Further study of disciplined physicians is necessary to identify physicians at high risk for offenses leading to disciplinary action and to develop effective interventions to prevent these offenses.
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                Author and article information

                Contributors
                Søren Birkeland
                Journal
                Journal ID (nlm-ta): Scand J Prim Health Care
                Journal ID (iso-abbrev): Scand J Prim Health Care
                Journal ID (publisher-id): PRI
                Title: Scandinavian Journal of Primary Health Care
                Publisher: Informa Healthcare (Stockholm )
                ISSN (Print): 0281-3432
                ISSN (Electronic): 1502-7724
                Publication date (Print): September 2013
                Publication date (Electronic): September 2013
                Volume: 31
                Issue: 3
                Pages: 153-157
                Affiliations
                1Research Unit of General Practice, Institute of Public Health, University of Southern Denmark , Odense, Denmark
                2Department and Research Unit of General Practice, Institute of Public Health, University of Copenhagen , Denmark
                Author notes
                Correspondence: Søren Birkeland, Research Unit of General Practice, University of Southern Denmark , J.B. Winsløws Vej 9A, 5000 Odense C, Denmark. E-mail: sbirkeland@ 123456health.sdu.dk
                Article
                Publisher ID: 823768
                DOI: 10.3109/02813432.2013.823768
                PMC ID: 3750437
                PubMed ID: 23906082
                SO-VID: 78a0d474-0a24-4a45-988a-6adcacc7ee34
                Copyright © © 2013 Informa Healthcare
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited.

                History
                Date received : 12 October 2011
                Date accepted : 12 June 2013
                Categories
                Subject: Original Article

                Keywords: communication,denmark,general practice,icpc-2,jurisprudence,patient complaints
                Data availability:
                Keywords: communication, denmark, general practice, icpc-2, jurisprudence, patient complaints

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