The heavy toll of Council investigations on doctors’ mental wellbeing  

Dr James Thorpe discusses recent research findings that highlight the detrimental effects Medical Council investigations have on the mental health of medical practitioners

Any readers who have faced an investigation from the Medical Council, or know a colleague who has, are aware of just how stressful it can be. At the Medical Protection Society (MPS), we support doctors with Medical Council investigations from the moment a complaint is received through to its conclusion. Doctors often tell us that the length of their investigation has the most impact on their mental health. Sadly, this comes as no surprise; we are aware of some complaints taking up to seven years to resolve, which is unacceptable.

New research from MPS supports our concerns about the impact of Medical Council investigations on the mental health doctors. In a survey of 114 doctors who have been investigated by the Medical Council in the last five years, nearly all of those who responded (93 per cent) said that the investigation caused stress and anxiety and 77 per cent said the investigation had a detrimental impact on their mental health. Of the respondents, 70 per cent said that the length of the investigation impacted their mental health the most and 53 per cent said that the tone of communications from the Medical Council affected them most.

Nearly a quarter (24 per cent) of the respondents considered quitting medicine due to their investigation, while one in 10 (10 per cent) either left, or retired early. Concerningly, one in 10 (12 per cent) also reported experiencing suicidal thoughts during their investigation.

One doctor who participated in our survey described the process as a “very stressful and difficult time” and said they developed depression and anxiety, losing confidence in themselves. Respondents also commented anonymously of feeling “guilty until proven innocent”, while others described Medical Council correspondence as “cold”, “legalistic”, and “hard to understand”.

MPS has made several recommendations for change across four key areas: Communication; the handling of spurious or minor complaints; mental health and wellbeing support; and length of process.

Delays

The investigation process feels excessively long and drawn out simply because it is. We know the Medical Council is in some respects bound by its regulatory framework and statutory obligations, which cause delays. But we believe there are several steps the regulator could take outside of the framework to improve their own processes. For example, the Council could implement a process which obtains consent from patients at the start of a case more swiftly, to avoid this delaying progress. It could also do more to ensure that the preliminary proceedings committee is provided with all the information necessary for them to make timely decisions when they first consider a complaint. A review into Medical Council processes, and the length of investigations, would be welcomed.

The Department of Health must also do more to ensure fewer doctors are dragged through this extremely stressful process unnecessarily. The Regulated Professions Act 2020 delegates the statutory powers to triage complaints to the Medical Council, meaning those not requiring further action could be closed swiftly, and it can focus on cases which potentially pose a risk to patient safety. The legislation is, however, yet to be commenced and this is becoming increasingly urgent.

Communication

We’ve heard from our members that the tone of the communications from the Medical Council and the initial notification of the complaint causes great stress, with one respondent saying that they “felt criminalised […] on trial from day one”. Another spoke of the delay in getting further details of the complaint, being told that they had an investigation, but being sent no further details for several days.

We have called on the Medical Council to conduct a review into all communications with registrants, on initial notification and throughout the process. Of the respondents in our survey, 51 per cent said that improvements to the tone of the communications would make the process less stressful. Approaching doctors with compassion and clear, understandable communications is a quick way to improve the investigation process. Breaking down complex legalistic language and shortening the communications would also reduce overwhelming the doctor and improve clarity and understanding.

Support

Another area in need of improvement is the level of support for doctors throughout the process. Recognising the stress of the process and signposting to wellbeing services is vital to provide doctors with support and reassurance – both throughout the investigation and at the point when the case closes.

The investigation process
feels excessively long and drawn out simply because it is

Spurious or minor complaints

Finally, we have called on both the Medical Council and the Department of Health to take steps to improve the handling of spurious or minor complaints. Many respondents expressed frustration about the regulator’s inability to triage complaints that were malicious, minor, or spurious. One survey respondent’s comment on this sums it up well: “I found the entire process extremely frustrating that one person with a spurious complaint can result in full preliminary proceedings committee review. The time taken to reply and provide all information was time taken away from caring for patients who needed help and jeopardised my ability to care for those who had need.”

Rapid implementation of the powers to triage complaints, as set out in the Regulated Professions Act 2020, could help shut down complaints that do not require further action more swiftly. This, in turn, would enable the Medical Council to focus on serious complaints that may pose a risk to patient safety. We understand the Council aims to protect the public, ensuring high standards of professional conduct among doctors, but we feel it could operate and communicate with doctors under investigation with more compassion. Acknowledging the stress of the investigation, signposting to wellbeing services, providing regular updates, and using clear, understandable language, will go some way towards achieving this.

We have met and had constructive discussions with the Medical Council on the issues identified in our report and their willingness to consider our recommendations is positive. We hope to continue this dialogue with the Council and other organisations to do everything possible to help bring about improvements.

We strongly advocate for immediate reforms to support doctors undergoing the investigation process.

One doctor quitting medicine, or worse, experiencing suicidal thoughts due to a Medical Council investigation, is one too many.