In the last article (Medicus newsletter number 10) we considered doctors’ various emotional responses to receiving a complaint, its impact on themselves and on patient care, and suggested that receiving trained professional psychological support was key to getting through.
But what of the ‘intellectual’ response that we have on receiving a complaint? We place a great deal of emphasis on the biomedical approach to practice (as does the Medical Council, Office of the Health and Disability Commissioner and so on), when we try and judge whether a doctor’s practice is up to scratch. We often ignore or only notionally recognise a patient-centred approach when these judgements are made (remember that at the heart of patient-centred medicine is the doctor-patient relationship and we have already established the damaging effects of a complaint on that), and what most doctors do is to review their notes, investigations and so on, searching for a reason or a justification for the events that unfolded. The problem is that doctors almost invariably, do this by themselves.
And that, is not how adults learn. Adults learn by reflecting on their experiences, adding to or altering their ideas and understandings. This allows change and new behaviours, and this is the definition of adult learning. It’s not just about facts! It is about good changes in behaviour, and not maladaptive learning where doctors change, but not in the right way.
The message is that in the context of receiving a complaint, you simply cannot do this reflection by yourself. Unfortunately, a common experience is that doctors await a report on their practice commissioned by either the prosecution or defence (or both) and that this is the only external input that might inform a change in how they behave. At Medicus we believe that members should have the opportunity to sit down with a trusted colleague, with protected time to review the circumstances of the complaint and as objectively as possible, consider what learnings might be made. This is independent of reports that lawyers commission, and there are ways of legally protecting the confidentiality of these discussions.
The bottom line? Contact Medicus and we will arrange appropriate collegial review wherever possible.
In the next issue we will tie together these ideas of emotional and intellectual responses and discuss the emergence and prevention of defensive medicine.
Wayne Cunningham
General Practitioner
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