Physicians under investigation need compassion, support

Physicians being investigated by a licensing body should be treated with respect and compassion, with an approach that supports physician health, Michael F. Myers, M.D., professor of clinical psychiatry at SUNY Downstate Medical Center in New York City, said in a recent article for Medscape Medical News.

Commonly, however, physicians find the experience to be bureaucratic and legalistic, which can lead not only to the widespread practice of defensive medicine but also dangerous physician psychological distress. "[As a psychiatrist], I heard physicians say that being sued for malpractice is less stressful than a complaint about a license because it really gets to the heart of who you are. It's not only what your license symbolizes, the privilege and the power that we have, but it's about our professional livelihood as well," he said. "It's perceived as an assault to self-esteem, self-worth and identity as a physician."

A previous study echoed these findings, discovering that being deemed unfit to practice is one of the key risk factors for physician suicide, FiercePracticeManagement has reported.

These problems are not exclusive to the United States. Doctors in the United Kingdom who had recently received or were currently receiving complaints reported significantly more depression, anxiety and thoughts of suicide than physicians who had not been involved in complaints, according to a study published in the BMJ Open.

Although the study did not determine whether the complaints process caused physicians' distress or their symptoms led to lapses in care, the authors contend that "physicians going through the complaints process are a vulnerable group that needs support." They went on to cite a U.S. study by the American College of Surgeons that examined the emotional toll of malpractice lawsuits on surgeons: "This study found significantly more depression and burnout in surgeons who had recently been exposed to a lawsuit and highlighted the association between burnout and the likelihood of making a medical error."

In addition to the data linking the U.K. complaints process to physician distress, the BMJ study revealed that 82 percent to 89 percent of all physicians surveyed reported that they now practice defensively by "hedging" (overprescribing, overreferring and taking excessive precautions), and 43 percent to 50 percent reported avoiding high-risk patients. This aspect of the study was concerning to Rob Poole, chair of the Royal College of Psychiatrists (RCPsych) in Wales and specialist adviser for the RCPsych's Invited Review Service. "That means that, as a consequence, it goes further than just an individual practitioner but into the quality of care that everyone else is getting," he told Medscape.

To learn more:
- read the article
- see the study from BMJ Open
- see the abstract from the American College of Surgeons