How to avoid a Medical Council complaint

Dr Edward Farnan looks at the most common complaints to the Medical Council and how best to avoid them

The Medical Council received 353 complaints about doctors in 2023, up from 301 the previous year. Of these, 61 complaints were referred for a fitness to practise inquiry and 49 inquiries concluded during the year.

The vast majority of complaints do not progress beyond the preliminary proceedings committee (PPC). However, the Medical Council said that the rise in complaints since the Covid-19 pandemic, combined with a higher referral rate from the PPC, had led to an increase in inquiries. They added: “Matters being considered by fitness to practise inquiries are becoming increasingly complex… which can often lengthen the investigation.”

So, while you are unlikely to be the subject of a serious Medical Council complaint during your career, it is worth knowing how to reduce the odds even further.

Grounds for complaint

According to the Medical Council’s 2022 Annual Report, the top five categories of complaints during the year were:

1. Treatment (eg, clinical examinations, diagnosis, and follow up);

2. Responsibilities to patients (eg, communication);

3. Professional practice (eg, prescribing);

4. Professional conduct (eg, dishonesty);

5. Medical records and confidentiality.

The following fictional scenarios are intended to illustrate some common problems, alongside the latest Guide to Professional Conduct and Ethics for Registered Medical Practitioners (ninth edition) and Medical Defence Union (MDU) advice. 

An NCHD agrees to carry out a complex
procedure and makes an error

The Medical Council says: You must practise and promote a positive culture of patient safety. This includes: Providing a good standard of practice and care, maintaining your professional competence, keeping your knowledge and skills up to date, reflecting on your practice, and working within your sphere of competence. (para 2.1)

MDU advice: Undertaking new tasks is a necessary part of professional development. However, if you feel that you are being asked to do something which is beyond your level of expertise or experience, you should raise this with the delegating colleague. Explain that you do not have the necessary experience and ask if you can assist or observe so you can undertake the procedure safely in future.

It is unlikely that a senior doctor would want to compromise patient safety and risk criticism of their own professional conduct by insisting, but if they are unavailable or will not listen, discuss your concerns with your line manager or educational supervisor and get advice from your medical defence organisation.

A patient who has been diagnosed with cancer
accuses the hospital consultant who first saw them of being dismissive and not listening to their concerns

The Medical Council says: Good communication involves listening to patients and colleagues, as well as giving information, explanations or advice. When communicating with patients, you should… be honest and give relevant information. You should welcome questions from patients and respond to them in an open, honest, and comprehensive way. (para 1.1)

MDU advice: Communication is consistently the single biggest factor reported in complaints to the Medical Council. Effective communication is about empathising with the other person and actively listening to them, as much as being able to express yourself clearly, without relying on complex medical terminology. No matter how senior you are, you should seek feedback on your communication style and reflect on how you can improve, including further training.

A doctor prescribes antibiotics for a patient without realising they are taking warfarin. The patient is
admitted to hospital with internal bleeding and
their family complains

The Medical Council says: You should only prescribe medication, treatment or therapy when you have adequate knowledge of the patient’s condition and believe that such prescription is indicated. You should ensure that any treatment, medication or therapy prescribed for a patient is safe and evidence-based. (para 34.1)

MDU advice: Failing to consider drug interactions and contraindications is one of the most common prescribing errors seen by the MDU. It highlights the importance of checking a patient’s history, both in their medical records and also asking them if they are taking something that is not documented (for example, an over-the-counter or herbal medicine). You should also make a note of this in the records as well as documenting any drug allergies – another common cause for complaint. 

A doctor is accused of plagiarism after submitting a paper which is found to include unattributed material

The Medical Council says: You must not claim authorship of work you have not written or contributed to. You have a responsibility to make sure any publication you are involved in is accurate. (para 57.6)

Communication is consistently the single biggest factor reported in complaints
to the Medical Council

MDU advice: Findings of deliberate dishonesty against doctors increase the likelihood of a sanction being imposed so it is vital to get prompt professional advice. To avoid inadvertent plagiarism, check every document that goes out under your name to ensure quotes are properly referenced. Take advice from a trusted academic if you are not sure how to do this correctly. Beware of paraphrasing without adequately attributing the provenance of ideas and add a reminder when making rough notes if a section of text is taken directly from another source.

An elderly patient complains when a doctor discloses their medical condition to a relative without their consent

The Medical Council says: People close to a patient, whether family, friends or support persons may, out of concern, request information about the patient. While their concern is understandable, you should not disclose information to them without the patient’s consent. (para 28.2)

MDU advice: Your duty of confidentiality requires you to seek consent to disclose information from patients who are able to make their own decisions. If you believe it is in the patient’s best interests for information to be disclosed (eg, because the family member is their main carer) you can explain why you think they need to know. However, ultimately, you need to respect the patient’s wishes, unless disclosure is required by law, the patient lacks capacity or it is necessary in the public interest. You should get advice from your medical defence organisation if you are unsure.  

In summary

A Medical Council investigation can take an enormous toll on your professional and personal life, even if the outcome is in your favour. If you are notified of a complaint, seek support from your medical defence organisation straight away.

MDU membership gives State-indemnified doctors access to expert guidance with medico-legal dilemmas like those above. We can support with Medical Council investigations, patient complaints, inquests, and criminal matters. To find out more see www.themdu.com/ireland