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Survey reveals significant toll HPCSA investigations are having on doctors’ mental wellbeing

18 July 2023

Medical Protection Society (MPS) has called for significant changes in how the Health Professions Council of South Africa (HPCSA) investigates allegations of unprofessional conduct against healthcare practitioners, as a new survey reveals the process is having a worrying impact on the mental wellbeing of the practitioners involved.

In the MPS survey of 204 practitioners who have recently faced an HPCSA investigation, more than eight in 10 (83%) said the investigation caused stress and anxiety, while 61% said it had a detrimental impact on their mental wellbeing

One in five (19%) considered leaving the medical profession or leaving South Africa to practise in a different country as a result of their investigation, and 1 in 10 (11%) said they experienced suicidal thoughts during the process.

In addition, 71% of practitioners said the length of the HPCSA investigation impacted on their mental wellbeing with some lasting many years, while 81% said the initial, unexpected notification of the investigation affected them most. Doctors commenting anonymously spoke of a ‘guilty until proven innocent’ tone in the initial HPCSA letter.

MPS, which protects the professional interests of over 300,000 healthcare professionals around the world, including more than 30,000 in South Africa, supports healthcare practitioners from the moment a HPCSA complaint is received, through to its conclusion.

The organisation says the survey results are a stark reminder that while the HPCSA has made improvements to its investigation processes, there is still work to do to ensure cases are resolved more quickly and do not impact on the mental wellbeing of those involved.

MPS Head of Medical Services, Africa, Dr Graham Howarth, said: “Through our work supporting members, we see first-hand how a HPCSA investigation takes its toll on the mental wellbeing of those involved, particularly the length of the investigation.

“We are aware of some complaints taking more than a decade to be resolved, which is unacceptable. We know the HPCSA is bound by its regulatory framework and there are statutory obligations which may be causing delays. We also recognise and welcome that the HPCSA has put some measures in place to help speed the process up, but we believe more can be done to expediate investigations by both the HPCSA and the Department of Health. Justice delayed is justice denied for both the complainant and the healthcare practitioner.

“We would also like to see improvements to the way the HPCSA communicates with registrants during an inquiry and investigation. For example, adopting a more empathetic tone, and making it clear in the initial letter that the practitioner under investigation is innocent until proven guilty, which may limit the impact on mental wellbeing.

“A practitioner under investigation should also be told how long the process should take and when they can expect updates, to reduce the stress around unknown timeframes and lack of communication, and the HPCSA should consider introducing an independent 24/7 wellbeing support service.

“The constructive engagement we have had with the HPCSA on this issue, and their willingness to consider a number of our recommendations, is positive. We hope to continue this dialogue and do everything possible to help bring about improvements for healthcare practitioners.”

Doctors commenting anonymously in the MPS survey said:

“The case has been dragging on and I am feeling desperate. I have also thought of leaving the profession as a whole.”

“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.”

“It places a strain on one’s mental wellbeing, you feel like a criminal, like you have deliberately set out to injure a patient, which is never the case.”

“When you receive communication from the HPCSA it in complicated legal terms and you feel as if you are already guilty and must prove your innocence.”

“The feeling of being unfairly accused of something, with the associated potential legal implications, is very unpleasant, and impacts negatively on all aspects of one's life.”

“It caused anxiety, this was prolonged because of the length of time it takes to finalise these matters.”

“It has had a massive effect on my wellbeing and functioning at work. The complaint came out of nowhere, it was totally unexpected. I had to take a few days off when I learned of the complaint and after the HPCSA said they needed me to attend a preliminary enquiry.”


Notes to editors

About MPS

The Medical Protection Society Limited (“MPS”) is the world’s leading protection organisation for doctors, dentists and healthcare professionals. We protect and support the professional interests of more than 300,000 members around the world. Membership provides access to expert advice and support and can also provide, depending on the type of membership required, the right to request indemnity for any complaints or claims arising from professional practice.

Our in-house experts assist with the wide range of legal and ethical problems that arise from professional practice. This can include clinical negligence claims, complaints, medical and dental council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries.

Our philosophy is to support safe practice in medicine and dentistry by helping to avert problems in the first place. We do this by promoting risk management through our workshops, E-learning, clinical risk assessments, publications, conferences, lectures and presentations.

MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.