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Death by 1,000 arrows



I am a big fan of those BBC4 documentaries where a presenter visits a green field somewhere and describes the events of an historic battle that took place hundreds of years ago.

There is something very thrilling about the drama of a bloody battlefield; the archers, the artillery and steam coming off galloping horses. But I have to remind myself every time that for the soldiers involved it must have been a extremely grisly experience.

I was reminded of this whilst reading the recent report commissioned by the GMC into 28 doctor suicides during fitness to practise procedures. It described the feeling of being investigated as ‘death by 1,000 arrows’.

The GMC says that complaints are an ‘occupational hazard’ and that doctors need the equivalent of a flak jacket and a helmet, in the form of resilience training, like soldiers in Afghanistan.

But it seems wrong to simply suggest that doctors need to toughen up.

And as an extraordinary study published today shows, there are disturbing affects on doctors and patients from the rising number of complaints to the GMC and others.

In the biggest study of its kind in the UK, nearly 8,000 doctors were asked about their mental and physical health after a complaint.

They found that doctors with a recent or ongoing complaint had significantly higher rates of depression, anxiety and relationship problems, compared with those without a recent complaint.

But more worryingly, the paper shows a drift towards defensive medicine that could cause harm to patients. Doctors with a recent or ongoing complaint were significantly more likely to change their practise, displaying ‘hedging’ or avoiding behaviour.

Shockingly, nearly a quarter said they had suggested invasive procedures ‘against their professional judgment’.

The researchers from Imperial College admit that they did not control for previous mental illness, and of course this could have played a role. Disciplinary procedures will inevitably be stressful and there are good reasons why complaints procedures are in place. It is preposterous to say that doctors who have done something wrong should be given an easy ride.

But the authors are convinced that it shows a relationship between complaints and actual harm that cannot be ignored.

There is no turning back the tide on what some call the ‘complaints culture’ in our society, but there has to be a way to minimise its damaging effect on doctors and patients.

Sensible suggestions – such as establishing a ‘national support service’ for all doctors – should be put into place as soon as possible. The length of investigations into complaints should be shortened and made less intimidating. Communication with doctors improved. Doctors not made to feel they are guilty before being proven innocent.

We need to pull the troops back and try to demilitarise medicine as much as possible.

Then, leave the battlefield to historians.

Nigel Praities is editor of Pulse.