Surgeons' experiences of complaints to the Health and Disability Commissioner

To investigate details of patient complaints to the Health and Disability Commissioner about surgeons-to identify factors in the patient-surgeon interaction that might make a complaint more likely, and to consider ways of improving the complaints environment.

A questionnaire was developed asking specific questions about surgeons and their practice, number of complaints since 1996 and specific questions about their last Health and Disability Commissioner complaint. The questionnaire was mailed to surgeons on the mailing lists of the New Zealand Orthopaedic Association and The New Zealand Association of General Surgeons. Anonymous responses were entered into an Microsoft Access database.

Responses were received from 280 (86%) of the 325 people contacted. Of these 280 replies, 259 were eligible for analysis. 149 (58%) of these 259 responses were from doctors who had received a complaint. There were 282 complaints, which gives an annual rate of complaints per person (inclusive of all respondents) of 0.16 over the 7 years: 1996 to 2002--but during 2000 to 2002 this rate was 0.34. The peak of complaints was in 2000. Those in mid-career (ie, 10-15 years of practice) and in private practice were at increased risk. Patients who complained were more likely to be female (58%) and in older ages. Respondents presented a very negative impression of their experience of the complaints process. In 91.1% of cases, either no action was taken or the surgeon was not in breach. Only 2.2% of cases were referred for disciplinary proceedings.

Complaints against surgeons are common. The 'highest-risk surgeon' is a subspeciality general surgeon in private practice. The most likely people to complain are middle-class, white females aged 35-70 years. It would appear likely that the present system does not resolve issues for the patient or the surgeon. Radical changes are needed, and are beginning to occur, in the complaints environment. Especially needed is acceptance and disclosure of harm and error (away from a culture of blame and discipline). Therefore, if medical practitioners are to move with confidence into this more open environment, a more supportive political/media/organisational culture is needed, with a focus on valuing disclosure and learning from mistakes.