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How to avoid complaints to the Medical Council

Having a complaint made against you can not only knock your confidence but can also affect your professional reputation as a healthcare professional. Dr Ming Keng-Teoh, MPS Head of Medical Services (Asia), gives advice on how to avoid complaints

The latest statistics from the Medical Council of Hong Kong (MCHK) reveal that the number of complaints about doctors increased from 461 in 2011 to 480 in 2012. The largest increase was seen in the area of ‘Disregard of professional responsibility to patients’, where the number of complaints had increased from 294 to 318.

All doctors have a professional responsibility to patients to provide good care and patient safety. As a doctor you must have a mutual understanding with patients of what professionalism means, and live up to the standards they set to help you achieve and maintain the highest quality of medical practice.

The breakdown of cases on ‘Disregard of professional responsibility to patients’ in 2012 was:

  • 140 cases: Failure/unsatisfactory result of treatment/surgery, failure to properly/timely diagnose illness and disagreement with doctor’s medical opinion
  • 84 cases: Fees and others
  • 53 cases: Inappropriate prescription of drugs
  • 15 cases: Conducting unnecessary or inappropriate treatment/surgery
  • 15 cases: Doctor’s unprofessional attitude/doctor-patient communication
  • 11 cases: Failure to give proper medical advice/explanation.

Consent

Since the 1990s, the failure to gain informed consent has become one of the biggest causes of clinical negligence claims against doctors.

Failure to gain informed consent has become one of the biggest causes of clinical negligence claims against doctors

Consent can be implied or express. The MCHK says implied consent for minor and non-invasive treatments “…can usually be implied from a patient’s conduct in consulting the doctor for his illness (but not in a situation where the consultation was only for the purpose of seeking an opinion)”.

Dr Teoh says: “It is important to gain valid consent from a patient before providing treatment or surgery. Failure to do so may result in the patient complaining afterwards that they are not happy with the result, or, if something goes wrong, they could try and claim against you. Patients need to be made aware of the risks and side effects as well as alternatives, including no treatment.”

The MCHK says the patient has the right to withhold their consent, provided they are competent enough to do so – that is, that they are able to exercise judgment clearly and freely. Any refusal must be respected and the MCHK says it is preferable that such refusals are documented.

Prescribing

Prescribing is another high-risk area. You should only prescribe drugs to meet the identified need of the patient and in their best interest. Ensure you are familiar with current guidance from the Hospital Authority Drug Formulary, including the use, side effects and contraindications of the medicines you are intending to prescribe.

You should be familiar with the Guidelines on Proper Prescription and Dispensing of Dangerous Drugs, found at Appendix E of the Medical Council of Hong Kong’s Code of Professional Conduct. Drugs of addiction or dependence should not be prescribed or supplied other than in the course of bona fide and proper treatment.

You should check that you are prescribing the correct dose of the medicine; this includes checking the strength, frequency and route. This is especially important in prescribing for children.

You also need to ensure that the patient:

  • is not allergic to the proposed medication
  • is not taking any medication (prescription, over-the-counter or alternative medicine) that may interact with the proposed medication 
  • does not have an illness that may be exacerbated by the medication.

Doctor-patient communication

Good communication between doctors and patients is fundamental to the delivery of safe and good quality patient care.

The public hold the medical profession in high regard. You should ensure that you observe proper standards of personal behaviour, not only in professional activities, but at all times.

Dr Teoh says: “Sometimes, in spite of your best efforts, patients will be unhappy with the care they have received. Patients who have lodged a complaint deserve a prompt, open, constructive and honest response including an explanation and, if appropriate, an apology.

If something goes wrong and an error is made, you should be open and honest with the patient involved.”

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