Originally published March 2018
At the end of a busy day, a physician sits down to read her mail. One letter is from her regulatory authority (College). Intrigued, but confident she is in good standing with the College, she opens it.
She is surprised by the first line, "This letter is to inform you that a complaint has been filed against you by…." Her heart races and her anxiety begins to rise.
Immediately she recalls a visit with the young man a few weeks before. She searches her office for his medical record and remembers that he wanted a prompt referral to a spine specialist, claiming a work-related injury. He reluctantly agreed to her examination, and was distressed when she insisted on filling out a workplace injury report. He was even more upset when she did not make the referral, but recommended non-narcotic analgesics and physiotherapy. As she reads her office notes on the visit, she realizes she did not adequately document the physical examination and did not record his anger. She picks up her pen…STOP!
This physician may be about to make a potentially serious mistake.
This scenario is similar to many real accounts told by CMPA members to our physician advisors.
In the CMPA’s experience, contacting a physician advisor, a physician with extensive clinical and medical-legal knowledge, is a good first step after being notified of a complaint. The advisor can help you with the complaint process, including managing the stress, clarifying relevant issues, and answering effectively. Most complaints do not require legal counsel, but a physician advisor can arrange legal assistance if needed.
Dealing with the stress
Many physicians who face a College complaint or an investigation suffer significant anxiety. To lower that stress, the CMPA suggests keeping the following in mind:
- Call the CMPA. We can guide you through the process and provide collegial support.
- You are not alone. Most physicians face at least one College complaint during their career.
- In complaint cases where a member requests and receives assistance from the CMPA, the large majority are dismissed outright or dismissed with concern (e.g. caution or advice).
- Help on managing stress can be found in the CMPA article, "Coping with a College complaint: Suggestions for reducing anxiety."1
Assess the complaint
Colleges typically notify physicians of a complaint by email, letter, or telephone. Usually they provide a copy of the complaint letter, but they may simply enumerate the complaint issues. Most review your prior experience at the College.
To assess the complaint, begin by determining who complained about what. Anyone—patients, family members, employers, insurers, social service agencies, or colleagues—can complain if dissatisfied with your care or conduct. Although most stem from a patient interaction, occasionally complaints involve activities outside your professional practice. These can be a concern to the College if they reflect poorly on your professionalism or fitness to practice.
Review the patient’s medical record when the matter is about a clinical event. However, if the record belongs to a hospital or other institution (e.g. clinic owner), contact the CMPA before accessing it. You may not be entitled to see the record if you are not part of the patient’s circle of care. A complaint does not necessarily mean you are in the circle of care. Irrespective, there are steps that need to be considered before accessing the hospital record to respond to a College complaint.
If the College requests a copy of the patient’s record and it is under the custodianship of another organization or individual, make them aware of the request.
After reviewing the record you may find inaccuracies or omissions. If this is the case, contact a CMPA physician advisor to help you decide on the next best course of action. Do not alter the existing record and carefully consider whether to add any information. Any changes to the record can impact your credibility and may lead to an additional charge of unprofessional conduct.
Finally, confirm that you understand what the College is asking you to do. If asking you to respond, Colleges typically give directions on how and when, including deadlines. While they expect a reply within their timeframe, they will amend a deadline when informed if there is genuine need.
Write a response
Before writing your response, contact the CMPA and speak to a physician advisor for guidance.
Your initial response should reflect what factually happened; the interactions with the patient, or a third party, or both; and your rationale for providing that particular care. Include your recollections of the encounter and the appropriate information from the medical record, clearly indicating where the information is from.
Use a respectful and professional tone. Avoid expressing anger, or being defensive, condescending or disparaging of the complainant or patient. Remain factual and avoid making subjective comments on others involved in the clinical situation.
It can be helpful if you can demonstrate to the College that you are able to assess your practice when an interaction with a patient was unsatisfactory. This means being able to consider the key issues in the complaint and determine if there are steps you could take to improve and mitigate the risk of a recurrence.
Many Colleges will send a copy of your response to the complainant, asking for further comments. Occasionally, this satisfies the complainant. Frequently, however, the complainant will send a second letter to the College, which the College may send to you for further comments.
If there are new issues to be addressed or clarification of previous statements, you should consult again with a CMPA physician advisor and send a second response to the College, if appropriate.
The College will consider the information from the complainant and the physician. If the medical issues are complex, the College might seek an expert peer opinion from an independent, uninvolved physician. On occasion, the College will seek information from witnesses such as your office staff or laypersons.
How does it get resolved?
In most cases, physicians successfully demonstrate their actions were appropriate medically and professionally, and the College takes no action on the complaint.
Sometimes physicians are criticized for being unprofessional in their interaction with the patient, even though the medical advice was appropriate. In these cases, physicians may receive a counsel or caution from the College. The College may suggest remedial actions such as targeted education or professional development, or other solutions, particularly where there are concerns about the care provided.
In more severe cases, where the physician’s actions lead the College to have serious concerns about conduct or competence, the matter may be referred to the College committee responsible for assessing professional misconduct or competency. Issues with physical or mental health may be referred to the committee responsible for assessing the physician’s fitness to practise.
How did our fictitious physician deal with her College complaint? Fortunately, she put down her pen, leaving the medical record unaltered, and contacted the CMPA. She successfully demonstrated to the College that her care was appropriate, but was required to do professional development on record keeping.
The bottom line
If you are notified of a College complaint:
- Call the CMPA. Speak with a physician advisor and visit our website to access helpful information on College complaints (see the Additional reading list, below).
- Assess the complaint. Determine what the complaint is about and what the College is asking you to do. Never alter a patient’s medical record after receiving a complaint.
- Respond professionally. In a respectful manner write to the College, addressing the concerns.
- CMPA [Internet]. Ottawa (CA):Canadian Medical Protective Association. Coping with a College complaint: Suggestions for reducing anxiety [cited 2017 Dec. 11]; about 2 screens. Available from: https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2013/coping-with-a-college-complaint