How To Identify Bad Apple Doctors

The bulk of patient complaints in Australia are directed against the same small group of repeat offenders, a new study has found. The report discovered that just 3 per cent of doctors account for nearly half of all registered complaints. The paper also identifies the risk factors that point towards a complaint-prone doctor.

Patient picture from Shutterstock

Over the course of the study, researchers from the universities of Melbourne and Queensland worked with health complaints commissioners in all states to analyse the 18,907 complaints made against Australian doctors in the past decade. The nature of the complaints ranged from diagnosis concerns to poor communication skills and bad attitude/manner.

The distribution of complaints among doctors was highly skewed: 3% of Australia’s medical workforce accounted for 49% of complaints and 1% accounted for a quarter of complaints.

To put it another way, less than 500 doctors have managed to amass an incredible 4,726 complaints over the past decade.

The strongest predictor of doctors’ risk of future complaints was the number of complaints they had previously had, along with specialty and male gender. Compared with general practitioners, plastic surgeons had twice the risk, and risks were approximately 50% higher among dermatologists and obstetrician-gynecologists.

Male doctors, meanwhile, had a 40 per cent higher risk of recurrence than their female colleagues. Repeat offenders were also more likely to be over the age of 35, with a 30-40 per cent higher risk of complaint recurrence. So if you want to avoid dodgy doctors, your best bet appears to be a female general practitioner under 35. We imagine this is a somewhat rare commodity.

The report concludes that the study could form the basis of new strategies for improving the quality and safety of health care. Via preventative mediation, it would also allow medical boards to avoid lawsuits before they happen.

Widespread use of this approach to identify high-risk doctors and target quality improvement efforts coupled with effective interventions, could help reduce adverse events and patient dissatisfaction in health systems. Immediate steps to improve, guide or constrain the care being provided by these ‘high-risk’ practitioners could be a very cost-effective way to advance quality and safety, and produce measurable benefits at the system level.

Have you ever been grossly misdiagnosed, overcharged or simply insulted by a medical professional? Share your horror stories in the comments section below.

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Comments

    I'd be curious (seriously) to see who, out of the people who made complaints against doctors, were chronic complainers. The sort who feel that nothing is ever done correctly and that they could do a far better job.

      Good point! Although when one doctor is stacking up multiple complaints from different patients, the issue probably lies with her/him.

      Maybe because people are entitled to be a little more discerning when it comes to receiving quality health care. Really, most GPs tend to be useless beyond giving flu shots or making diagnoses of the most common ailments. Best advice is to spend the time to find that 1 in 10 doctor who actually knows their shit, and not just some half-arsed pharmaceutical company sales rep counting their progress towards their next BMW by the number of consultations they make. Once you find a good doc, stick with them as long as you can (until either you or the doc moves, retires, dies, etc). ... Also goes for car mechanics

        There's a difference between being discerning and just being a whiny jerk. A discerning person finds the doctor unprofessional, (possibly) makes a complaint and goes to another one, the whiny jerk finds ALL doctors unprofessional and writes complaints for all of them, like Ned Flanders recording all the TV shows and dutifully reporting every issue he finds.

        And I don't know what doctors you go to, but the 12 I've seen in the last few years have been decent. They're keen to tell you everything will be fine with some bed rest and some medication (by the way, most medication has a generic or alternate version available, so while some may be sales reps, you do have a choice in what brand of medication you get) but you're more than welcome to ask for a second opinion and in the past, we have, as we've felt that the doctor was keen to just shove us out the door

        Besides, while a doctor has a program that can look up symptoms and such, they can't be expected to know everything, and they may see a particular problem so many times, they start to assume that it's the same issue as everyone else (like a mechanic assumes it's your spark plugs when your car doesn't accelerate as fast as it used to)

          Agreed, although obviously you have had better luck with GPs. My experience has been they were usually more interested in getting me out the door than to provide genuinely useful or good healthcare. And your assertion that many doctors "...start to assume that it's the same issue as everyone else" is a bit worrying, and only underlies my general distrust of doctors as a rule. I think I'd be justified to make a complaint against any doctor who assumed something while making a diagnosis.

          Everything else you say, I think I covered in my original comment :)

        Wow.
        Do you realize that that "glory days" of actually being "wealthy" in General Practice is well and truly gone? If you want do make money, do mining, or banking but DEFINITELY not medicine. About the best you can do is be "better than average."

        I work in ED and had a drunken 21yo miner deck one of our nurses yelling "F**# you I can f*** buy alls of you C*(*#*! I F*** make 210 grand!".

        You want to know what I was doing at 21? IT Phone support, Customer Call Centre for NRMA and working in the local Deli whilst studying my arse off. Before that? Doing your fries at Maccas. And now, I'm practicing and I don't make ANYWHERE NEAR 100,000, yet alone 200,000!

        Consider also the SACRIFICE that Medico's suffer. No OTHER profession asks students to uproot themselves at the CHANCE of studying and to go interstate. 4 years (if a postgrad, 6, if undergrad) of poverty in medical school is the SHORTEST and the LEAST important part of our training (Get a Job? Guess what, most who do FAIL a year); there's 1 year internship, 2-4 yrs residency (skutt work), and IF you make it into a specialization, then that's a MINIMUM of 5 yrs, to 7 yrs if you choose surgeries! General practice is the "fastest" of the specializations, and that's 4 years if you're BRILLIANT.

        All in, you're looking at someone who's trained the better part of 8-16 yrs. Do you think we'd deserve SOME BLOODY REWARD?

        Oh, and after you've done that, do you THINK you can practice down the street in some nice leafy green suburb? NO. The government passively CONSCRIPTS you by telling you, "you know, what, you can practice WHEREEVER you want... but if you want to bill Medicare, then you need a provider number. And if you want a provider number... well, we're only giving that out if you move 200km east of Shepard's Crossing."

        WOULD YOU TOLERATE THE GOVERNMENT TELLING YOU WHERE YOU CAN WORK, AND NOT GETTING PAID ANY MORE FOR IT? ANY OTHER INDUSTRY, and our union would be screaming.

        No, here's a FACT. You heard of CPI? That's the cost of LIVING. Medicare is indexed to 0.5 CPI, that means that whilst I'm presuming you're employer is increasing your wage to at least MATCH the increased costs of EXISTING, somehow the government has decided, no, doctors can just try and work harder.

        Rent, Electricity, Receptionists, Phone, Internet and LIVING all increase WITH CPI.... INSURANCE is another matter! OBGYN, $100,000 BEFORE even seeing a single patient. It goes UP with each consult you do. Tax? Well guess what, I had to take out a BANK LOAN because the in Australia for some reason, it's OK to DEMAND the payment of Tax BEFORE I've even had a chance to earn it!

        RESULT: GPs HAVE ACTUALLY GONE BANKRUPT!

        And you know what GOOD OLD SCHOOL doctors have just had enough and just shut up shop. Can you BLAME them? That also means that the knowledge pool available to trainees goes DOWN.

        You see an "Accreditation" sticker on your GP's door? That sticker costs on average $50,000 for a 2-person practice in terms of program and "upgrades" (really, a compactus is "more secure" than a locked filing cabinet?").

        So in the end, what the community gets are corporate-run clinics that focus on the bottom line.
        You're "rushed" in an out because the GOVERNMENT has mandated FINANCIALLY that in order to stay viable GP's have to, on average, have a consult extend no longer than 12.5mins. Of COURSE there's no official POLICY on it... you just go BROKE!

        Consider also, this is a profession where by day in and out, all you deal with is grumpy miserable people who complain... it takes a certain kind of person who can deal with this kind of stressful situation not day in and day out, but 10 minute block by 10 minute block, and to "reset" yourself emotionally so that the NEXT patient has no idea what happened in your previous consult!

        The sad fact is that it's just human nature. Things that are free are taken for granted. Humans are arseholes. It's human nature. Now instead of realizing that subsidized medical care is meant to improve the health status of society as a whole, and to ensure that even the most impoverished Citizen has a semblance of care, it has turned into a situation where people act as consumers and walk in with an attitude that they are not there for diagnosis, treatment and advice, but that doctors are no better than the poor harranged cashier at McDonalds. "I've got a medicare care and you're GOING to do this!" True story. Guess what, just becuase you've read off Dr Goooogle that injecting day old urine and fish oil into your joints is good for arthritis, I'm not going to do it because I'm a professional, that therapy is not something I've been trained in, nor is there any evidence for it, and you know what, It's against my professional judgement. i've been trained the better part of my adult life to take care of people, and i'm damn good at it. I don't get it right all the time but I try my damnest.

        Yes, there's good and bad doctors out there. Look at YOUR OWN vocation. But you know what, the vast majority of doctors are just like me. We want what's best for our patients, and we've sacrificed a FUCKLOAD to get to where we are (Psychiatrists - high suicide rate; Surgeons average 3.5 divorces; >90% of the medical profession has some underlying chronic disease state that could be corrected by LEAVING the profession; 60% have social drug abuse issues (smoking, alcohol, prescriptive).

        So you know what, BEFORE you complain, how about you think for ONE second.... Would YOU want to go through all that to be a doctor? Would you sacrifice all your weekends at the pub for studying; would you spend an entire Easter holding down the fort at an Emergency department for 48hrs with no sleep? Would you be ready to do exams and CPD training equivilant of sitting Yr12 EVERY YEAR?

        Next time you see your doctor. How about at least a SMILE. How about just a "Hey Doc, how you doing?" You'll make his/her day whilst they reply "Ok, but I'm more concerned about how YOU're feeling... now how can I help you?" And you know what, at the end of the consult.. just say "Thanks for your help, Doc." Because you know what? That's why we got into this biz in the first place.

        Just of interest: you might want to look at this bit of insight:
        http://youtu.be/iUbfRzxNy20

        Last edited 13/04/13 7:49 am

          My GP doctor who is also a Psychiatrist, after reading my book that I had written on my intense psychological abuse from my father, decided that I was a threat to my mother whom I still live with and started lying to me about the serology test results that I requested my doctor do for Celiac Disease in order to paint me as a nutcase. She done the IgA and DGG test results but failed to do research on how to properly interpret the results, she didn't mention that a low IgA nullifies the blood tests for Celiac Disease and instead labelled me with Schizophrenia. Not only did she ignore the DSM which states that no patient must be labelled with a mental health condition until gastrointestinal disorders are first ruled out.

          She wanted to punish me and label me with a life-changing diagnosis, then lie to me repeatedly to hide the fact that my blood test was probably positive for Celiac Disease.

          People seriously share their innermost thoughts to these people?

          So you think after studying and working toward a degree for years entitles you to lots of money, and here you're complaining that you have to work hard for your money? I'm sorry but I fail to empathise with your situation. You go into the profession fully aware of the risks and rules, and you complain that its rules and regulations are not convenient?

          You should stop thinking "OMG being a doctor is hard work". Think about other people where they have to work long hours with very little money. Your situation is a lot better than most people. Think about police officers, who must deal with criminals day in day out and got paid nowhere near you. I think you have a lot to be thankful about.

      Thanks for your comment Grayda. We weren't able to quantify the exact number of patients who made repeat complaints but my impression in reviewing these 19,000 cases (and that of the health commissioners who resolve the complaints) is that it's very rare. Almost all of the high-risk doctors were the subject of multiple complaints from multiple unconnected patients.

        Personally I found the standards of medical profession in Australia shocking. There are some good doctors, but there seem to be little effective disciplinary measures against the unethical and incompetent doctors.

        As with the complaints of the doctor as an indicator of his/her competence, I found review sites such TrueLocal and Google can be very biased when it comes to publishing customer reviews.

        Also I found the comments here that blames the victims, very disturbing. No wonder bad doctors can get away from being the bad apples, if they are shielded by a media (internet in this case) presence that always point fingers at the victims. Doctors cannot help patients if they refuse to see the symptoms. In the same way, social ills can not be healed, if the victims' voices are denied, discounted or distort.

        By the way, I found myself unable to vote up or down the opinions. Why is that?

    GP's here are shocking these days. I understand the pressures they are under combined with a wealth of whining wussy folk who go in for a sniffle or a scratch but you just feel like you are on an assembly line these days.

    I've been misdiagnosed and wrongly prescribed medication far too often as has many in my family.

    On a personal note my Uncle actually passed away due to a doctors negligence so we are all pretty anti doc BUT we do have good reasons, our experiences.

      Not all GPs are incompetent-I think it might be starting to get to the point where we will need to pay upfront to see GP's (private fee structure), to weed out the 'time wasters'.
      Like any profession, you need to shop around to find a Dr that suits your needs and that you feel you can be open with and get the best healthcare from.

    These results are not surprising. The same probably goes for any industry where a few tar the reputation of the many.

    Of course for doctors the consequences of mistakes are potentially severe. But the country can reassure itself that these data also show that the majority of doctors aren't flagging concerns from their patients. And that various regulatory bodies both federally and locally police the medical profession heavily ... especially when complaints are made.

      Agreed, our research findings are actually a good news story for most doctors. Around 80% of doctors had no formal complaints to a regulatory body over the decade under study, and the remainder had just one or two isolated complaints. However, a small group of high risk doctors were incurring complaint after complaint. We need to focus on identifying this group early and intervening to prevent further harm.

    Repeat offenders were also more likely to be over the age of 35

    Given most doctors complete their training well into their 30's, this might explain that statistic. By the time you're a repeat offender (ie at least 2 strikes) you should at least be out of your 30's by then.

      Thanks for your comment Johann. We did control for the number of doctors in each age group and found that, all else being equal, an older doctor was still more likely to have another complaint within two years than a younger doctor. However, as you point out there are limitations to this finding - for example many younger doctors work under the guidance or supervision of an older doctor and where a number of doctors were involved in an adverse event, the complaint may be made against the most senior doctor in the team.

    Where can I read the full report of the study. Presumably its been published somewhere?

    Hi Paul, the paper is freely available through BMJ Quality and Safety. A google scholar search for M Bismark National Study of Complaints should bring it up or you can contact me at the University of Melbourne. There are two associated editorials by Ron Paterson and Wendy Levinson in the same issue.

    Considering it's the bad apples farming most of the complaints when will there be a public complains register so that we can see which specialists to avoid. 6 years ago I asked for a recommendation for a paediatrician for my kids and was directed to the biggest ego in the region who is incapable of working with others and objects to second opinions.....and so I have found out since has traumatised numerous children not just my own, with his ego. My 13 yo walks straight back out if his name is even on the board at any of the consulting offices iv had to go to. Even if she isn't seeing him. He has a nasty habit of invading consults with other paediatricians and overriding their advice and cancelling all referrals. Yes I have complained in response he had my daughter black listed in the region. Years of delays in diagnosis and grief caused by this humiliating my children could have been avoided if you could check how many strikes they had against them.

    When only he holds his opinions.....something is wrong particularly when he bullies others into submission in the field.

    A week ago I went to see a Doctor at a local practise. I had not been for over 6 months and had never seen this doctor b4. The experience was not good. She told me I was lazy by just one look and was not interested in any type of examination. I am overweight but if she had been civil and asked about my history she would have learnt that I have had a thyroidectomy, hysterectomy, oophorectomy plus removal of gall bladder, all due to cancer in the last 22 tears. I had a serious break in my ankle also 22 years ago which has developed severe osteoporosis the last 3 years. Before this, I walked over 5km 6 days a week besides the normal toil of a dairy farmer.

    I walked out of the appointment as I had had a gutsful of her demeanour and she had brought me to tears. I am not a sook either.

    I tried to look her up on APHRA's web site and could not find any details. Rang APHRA and they put me onto OHO. They could not find her registration under her practice name either so they asked me to go back to the clinic and ask them for her registration details. I did this and they flatly refused citing privacy laws.
    So I laid a complaint with OHO. 4 days later they got back to me and said they would not take the complaint any further as the doctor denied the conversation. They did give me her registration number which had a slightly different name than what she practises under. I noted previous complaints on her file plus she could only practise under level 2 restrictions. Wish I had access to this info earlier. I am left with finding a new practice with a decent caring doctor. Townsville based.

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