Tone of communications
41% of doctors who responded to the survey said the tone of communications from the HPCSA impacted on their mental health most during the inquiry or investigation
28% of doctors said that if the process was less legalistic/adversarial it would have made it less stressful.
13% of doctors said that less legalistic language in communications would’ve made it less stressful.
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“When you receive communication from the HPCSA it is in complicated legal terms and you feel as if you are already guilty and must prove your innocence.”
“I feel the situation is handled really poorly from the HPCSA side. You get a legal letter out of the blue, need to notify MPS and immediately get a lawyer. It feels like I'm guilty before I can even start the procedure. The whole procedure is drawn out and you are made out to be a criminal.”
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Recommendations:
- The HPCSA should consider reviewing the tone of its communications and adopting an empathetic yet factual approach to limit the impact on doctors’ mental health. They should consider making clear in their initial letter that their starting position is that the doctor under investigation is innocent until proven guilty. We are happy to work with the HPCSA to address this.
Frivolous / spurious complaints
64% of doctors said better screening of unreasonable complaints would’ve made the process less stressful.
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“The complaint appeared to be essentially frivolous and devoid of substance, directed at the wrong doctor (me) and no attempt whatsoever was made by the HPCSA to ascertain any circumstances. It took over 2 years for a final response from the HPCSA to give an opinion that there was no basis to pursue the matter.”
“This complaint was brought by a disgruntled family - it should never have been allowed to proceed. The HPCSA is dominated by lawyers with little medical insight and has become increasingly aggressive in their dealings with practitioners. Prior to Covid the HPCSA ran a radio advert encouraging patients to take legal action against their doctors if they were not happy with them. Their motto of "Guiding the profession and protecting the public" is laughable.”
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Recommendations:
- While we understand that the number of complaints to the HPCSA has reduced in the last year, the HPCSA should continue to work on managing minor complaints more efficiently when the Registrar and the Ombudsman become involved at the beginning of the process.
- The HPCSA should be discouraged from actively seeking and encouraging complaints about its registrants – this invites minor or spurious complaints and often results in practitioners facing a long, stressful process unnecessarily.
- The HPCSA could encourage an alternative complaints resolution processes such as mediation, which allow patients to work with the healthcare provider and resolve complaints locally - similar to the complaints resolution mediation service established by SADA. This would enable quicker resolution for patients and practitioners, and reduce the number of minor complaints directed to the HPCSA, so it can focus on cases that potentially require action to protect the public.
Delays and lack of updates
71% of doctors said the length of the process had the most impact on their mental health.
53% said that if the process was completed more quickly it would’ve made it less stressful.
41% said more frequent updates on how the inquiry or investigation was progressing would’ve made it less stressful.
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“I am currently waiting for communication from the HPCSA, but haven't received any on a complaint lodged 6 years ago. No response despite series of enquiries.”
“The case took 10 years....devastating on mental health.”
“After submitting our response to the complaint it took HPCSA 2 years to respond in accepting our explanation which is obviously not acceptable.”
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Recommendations:
- The HPCSA should consider including in its initial communication with a doctor, how long the process should take and when the doctor could expect updates, to reduce the stress around unknown timeframes and lack of communication.
- We acknowledge the HPCSA is putting measures in place to address the issue of delays. We believe they should actively continue to look into measures to reduce delays and length of the investigation process. Justice delayed is justice denied for the complainant and the healthcare practitioner.
- We understand that the HPCSA has included people with healthcare experience at the preliminary inquiry committee stage. This is encouraging and the HPCSA should continue to ensure investigators at this stage are suitably experienced and medically qualified in order to be able to close those cases clearly not requiring further action swiftly. The process is currently very lawyer driven.
- We acknowledge that the HPCSA is bound by its regulatory framework (based on the Health Professions Act 56 of 1974) and there are statutory obligations which may be causing delays. The Department of Health and the HPCSA should consider changes to the regulatory framework which may facilitate faster resolution of cases.
Fine driven
Some doctors responding to the survey left comments about the HPCSA’s financial motivations.
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“HPCSA is just ready to issue fines without taking into consideration the merits of cases in its entirety. If there’s a complaint, almost invariably you will be fined.”
“Impression is that you have no choice but to pay the penalty for the process to end, irrespective if you were right or wrong as a fair trial / judgment is unlikely.”
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Recommendations:
- There is a perception that the HPCSA is being funded by fines. However, the annual report includes data to prove that this is not the case. The HPCSA should reassure the profession that this is not the case.
Initial communication
81% of doctors said the initial, unexpected notification of the inquiry or investigation affected their mental health most.
41% said the tone of communications from HPCSA affected their mental health most.
30% said improvements in tone of communications would’ve made the process less stressful.
40% also selected ‘having to deal with communications from the HPCSA’ as affecting their mental health most.
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“An email that shatters your whole world is really not a very positive experience. I really think a phone call before the email is sent is appropriate.”
“An outline of how the process usually proceeds and what to expect in the investigation process would ease the stress.”
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Recommendations:
- The HPCSA could take inspiration from steps regulators in other international jurisdictions have taken to reduce the impact the initial notification can have on practitioners’ mental health – for example, the UK’s General Medical Council has rolled out initial contact by phone, prior to a letter being sent, and has also committed to not sending initial communication on a Friday when access to professional and wellbeing support may be more limited. We would recommend that the HPCSA avoids sending email communications on a Friday so that registrants can access support if needed.
- The HPCSA should avoid naming other practitioners in their correspondence to registrants to protect doctors’ confidentiality.
Wellbeing support
6 in 10 (61%) said the investigation had a detrimental impact on their mental health.
1 in 10 (11%) of the 204 respondents experienced suicidal thoughts during their investigation.
52% believe the HPCSA should offer more support when facing an inquiry or investigation.
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“Depression, anxiety, loss of confidence, doubt in professional competence.”
“Caused extreme anxiety and depression. Required medication and psychotherapy.
"Considered leaving the profession. Also stopped doing certain surgeries, because I can't cope with the stress it can cause medicolegally.”
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Recommendations:
- The HPCSA should ensure that all communication and material for practitioners facing an investigation or inquiry signposts to appropriate mental wellbeing support resources.
- The HPCSA should also consider introducing a 24/7 wellbeing support service for practitioners facing an inquiry or investigation, provided by an independent party. Medical Protection offers counselling to any members experiencing work-related stress, or stress that they feel could impact their practice, however there are registrants who may not have a Medical Defence Organisation.
- The HPCSA should consider including in its initial notification letter, an acknowledgement that receiving the letter and the process of investigation may be stressful. This will show empathy and understanding which could in turn reduce stress on the registrants.
- The HPCSA should consider including in its initial communication with a doctor, how long the process should take and when the doctor could expect updates, to reduce the stress around unknown timeframes and lack of communication.
- There is a perception that the HPCSA is being funded by fines. However, the annual report includes data to prove that this is not the case. The HPCSA should reassure the profession that this is not the case.