Originally published April 2013
Physicians who face a regulatory authority (College) complaint or an investigation report feelings of anxiety and stress. Gaining a sound understanding of the stress associated with the complaint process can prove helpful to all physicians given that most will be confronted with a College complaint in the course of their career.
Over the years the CMPA has conducted a number of surveys with members who have received a complaint. These surveys confirm that members consistently suffer significant anxiety — often greater than what they experience when involved in a legal action.
When the complaint escalates to an investigation, physicians' stress can become more intense and turn into distress. The surveys also reveal that the lengthier the College process, be it a complaint or investigation, the greater physicians' stress.
Some physicians have difficulty coping even when the complaint is unfounded and the final outcome is favourable. Many are stressed by what might be perceived as an error or criticism. Physicians express feeling betrayed by patients who launch a complaint and a number admit to feeling ashamed and reluctant to talk about the issue with colleagues or even family members. Some physicians have difficulty sleeping or concentrating, and some slip into depression. Others admit losing confidence in their clinical skills and judgment, regardless of the outcome of the complaint. Some report being devastated. A few consider leaving medicine or changing the scope of their practice to minimize the risk of future complaints. As physicians struggle to maintain normal behaviour, members of their family can be affected as well.
Focusing on the outcome can help
To help address stress, it is important for physicians to understand the complaint process so they can put the complaint in context and maintain perspective. While all complaints must be taken seriously, of those with a known outcome, more than 75% are dismissed outright or dismissed with some concern (e.g. education, caution, advice).
Colleges may identify an area of weakness in the physician's practice and view the complaint as an educational opportunity that benefits the physician. Some Colleges request physicians prepare a document about a particular topic. Other Colleges may ask physicians to meet with a registrar. A small number of physicians may be required to take a remedial course, such as a medical records training or a communications course, if multiple complaints have identified a need to improve their interactions with patients.
A very small number of College complaints progress to an investigation into a physician's practice. Rarely do Colleges revoke or suspend the licence of a physician. Slightly more than 1% of physicians voluntarily resign, retire, or limit their practices in some way. In 4% of CMPA cases involving College complaints there is a concurrent civil legal action (lawsuit).
Strategies for coping
Physicians should remember that they are not alone in experiencing the emotional stress of a College complaint and recognize the importance of taking care of themselves. Here are a few points to keep in mind.
Getting enough sleep and eating well allows physicians to sustain the physical strength they need to withstand mental stress. Exercise is beneficial, but it is also important that physicians maintain a social life and not slip into isolation and despondency. Self-medicating or increasing alcohol consumption should be avoided.
Analyse issues objectively
Viewing the situation objectively and honestly allows physicians to keep the complaint in perspective. Preoccupation with the issue heightens the potential for making an error in their professional and personal life, so physicians must be self-aware and set limits on how much time they spend thinking about the complaint, and then make time to remember all that is going well.
Using the best friend technique allows physicians to treat themselves as they would treat their best friend. If they have made an error, they should allow themselves the same understanding they would accord to others. There is no need for judgment. It is important to learn from what has happened and move forward.
Respond professionally to make improvements
Knowing they have responded professionally in the face of criticism can reduce physicians' stress. They should focus on what can be learned from the complaint as it relates to their practice, their knowledge, and their clinical skills.
Seek personal support
Physicians do not have to go through the complaint process alone. They should stay connected and maintain normal relationships with patients, colleagues, family, and friends.
Seek resources and professional help
If necessary, physicians should seek professional counselling from their family doctor or consider using the services of the Physician Health Program, which is available in most provinces.
Increased awareness of the issue has led to the publication of many books and guides to assist physicians. As well, members can access a section of the CMPA website dedicated to physician wellness. The Association has published the article "Understanding how Colleges handle complaints or allegations of professional misconduct."
CMPA is here to assist
When a member calls the CMPA about a College complaint, medical officers, who are physicians with extensive medico-legal experience, respond with professional and collegial support. They give advice on the complaint process and review the member's written response to the College. They also help physicians keep the complaint in perspective, providing members with direction on how to manage and focus on the issues raised.
Recognizing signs of stress, providing emotional support, and directing physicians to available resources are also part of the services provided by medical officers. Whether through its web resources, or through confidential telephone advice, the CMPA can support physicians in the face of a College complaint. Call the CMPA at 1-800-267-6522.