The inevitable stress and anxiety of an investigation by the HPCSA can be lessened, or at least reduced, with a different approach, subtler notification and speedier resolution, writes Dr Volker Hitzeroth, medico-legal consultant for Medical Protection Society.
He writes:
In last month’s MedicalBrief column, we discussed a recent case where MPS represented a member in the Gauteng High Court (Pretoria) regarding an HPCSA complaint alleging unprofessional conduct. The complaint was brought against our member in 2008, yet the HPCSA had still not started proceedings at the time of the legal suit.
The court ordered that the complaint against the practitioner be permanently set aside and that all existing disciplinary proceedings related to the complaint be terminated.
The judge described the case as a “tale of institutional inefficiency, demonstrating the traumatic and adverse prejudicial impact on the well-being of a professional medical practitioner accused of unproven misconduct”.
Unfortunately, cases like this, where members feel they are caught in a seemingly never-ending HPCSA process, are not uncommon.
A recent survey conducted by MPS highlights the impact an HPCSA investigation can have on a doctors’ mental well-being, and how the stress of being investigated by the regulator is compounded by the length of the process.
Of the 204 doctors who participated in the survey, having faced an investigation in the past five years, 61% felt the investigation had a detrimental impact on their mental well-being and 83% said it caused stress and anxiety. And 71% said the length of the process impacted on their mental well-being most.
It should be added that these sentiments are not exclusive to the HPCSA process. We have conducted similar surveys in other jurisdictions where we support members with regulatory investigations. Being under investigation by any professional regulator for a period of time takes its toll on the practitioners involved – including on their confidence, personal lives and relationships.
For some, the investigation, regardless of outcome, has even resulted in practitioners considering their future in healthcare. In our survey nearly one in five (19%) considered leaving the medical profession or leaving to practise in a different country because of their HPCSA investigation.
While delays of more than a decade are hard to excuse, we do recognise that the HPCSA, just like many other regulators around the world, is bound by statutory obligations that can cause delays to the process. Making changes to the regulatory framework is something the HPCSA and the Department of Health could consider to help facilitate faster resolution of cases.
There are, however, other steps the HPCSA could also consider outside of making changes to the regulatory framework, which admittedly could take some time. The HPCSA has already established some measures to help speed up their process, and while this is welcome, we hope more can be done.
For example, it could encourage alternative complaints resolution processes within health establishments, such as mediation, allowing patients to work with the healthcare provider and resolve complaints locally and promptly. This would enable quicker resolution for all, and also reduce the number of minor complaints directed to the HPCSA so it can focus on the most serious allegations and protecting the public.
Delays to the process are not the only cause of stress to practitioners: 81% cited the initial, unexpected notification of the investigation as affecting their mental well-being, and 41% said the tone of communications from HPCSA affected them most.
In the past month we have had constructive engagement with HPCSA colleagues, and made several suggestions in these areas.
For example, the HPCSA could undertake a review of its communications to practitioners, to ensure the tone is more compassionate and acknowledge that notification of an investigation into their professional conduct, and the process which may follow, may prove stressful.
The HPCSA could also look at changes professional regulators in other jurisdictions have rolled out after similar feedback about the shock and fear accompanying receipt of an initial notification of an investigation.
For example, the United Kingdom’s General Medical Council has recently, after a pilot project, rolled out initial contact by phone before a letter is sent. It has also committed to not sending an initial notification on a Friday when access to legal and well-being support may be more limited.
We also believe it would reduce stress around unknown timeframes, and lack of communication, if the practitioner under investigation is told how long the process should take and when they can expect updates.
These may seem like simple measures, but such relatively small changes could mean much to the practitioner on the receiving end of a potentially career-changing – and sometimes life-changing – letter.
Clearly there is much that can be done, and we are keen to continue our dialogue with the HPCSA and share our international experience to help develop some of the ideas discussed above.
Being investigated by any regulator will never be pleasant, but we believe it could be a swifter, more palatable and less stressful experience, and we are absolutely committed to helping to bring about positive change for our members and the healthcare profession as a whole.
See more MPS columns from MedicalBrief archives:
Court sets aside complaint after HPCSA's long delay in handling case
How to navigate medico-legal matters in healthcare practice
The need for medico-legal reform: A welcome chance to speak up