Friday, 19 April, 2024
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Healthcare system burdened by ill-considered malpractice cases

There are growing concerns that patient care and doctor well-being are being undermined by the high number of ill-considered and unfounded cases brought against medical practitioners in South Africa.

Statistics from the Health Professions Council of South Africa’s 2022/2023 annual report reveal that of the complaints, just 9% were referred by the HPCSA to an inquiry before a professional conduct committee.

Of the complaints which were considered by the committees of the Preliminary Inquiry of the Medical and Dental Professions Board, it accepted 39% of the explanations, a further 3% were closed or withdrawn, 12% required further information, 11% resulted in guilty fines, 11% required consultations, 6% could not be decided due to time constraints and the balance related to a various miscellaneous issues.

These numbers emphasise that a substantial portion of complaints of unprofessional conduct brought against healthcare practitioners in the medical and dental profession lack merit. It also tends to suggest that many of these complaints are not closed promptly as they are subjected to time-consuming, costly and extensive committee reviews.

In light of National Doctors’ Day on 16 November, a leading professional indemnity provider of surgical specialists, EthiQal, highlights the impact that poorly considered allegations have on the healthcare sector.

In South Africa, the doctor to patient ratio is about 0.31 doctors per 1 000 patients. Dr Hlombe Makuluma, clinical risk management specialist at EthiQal, says: “In this context it is patients, who end up paying the price of hasty and sometimes unjustified legal recourse against healthcare professionals.

“After ill-considered allegations, some doctors stop practising altogether or reduce their scope of practice, given fear of future litigation, further exacerbating South Africa’s critical doctor shortage. Others become defensive in their practice and push up healthcare costs unnecessarily by performing tests aimed at mitigating their medico-legal risks.

“This is costly, especially to the patient, and can be based more on mitigating the doctor’s own risk, rather than on what they feel their patient requires.”

The threat of aggrieved patients reporting doctors to the HPCSA, or demanding compensation or, in the worst cases, laying criminal charges against them, can take a massive toll on the mental well-being of healthcare professionals.

“A condition known as medical malpractice stress syndrome (MMSS) has been recognised as affecting medical professionals who are subjected to litigation. This disorder, which includes severe anxiety and depression and physiological changes relating to immune and endocrine functions, speaks to the often profoundly negative impact unfounded allegations can have on doctors,” said Makuluma.

South Africans are urged to openly discuss their grievances with their treating doctor before reporting the practitioner or taking legal action.

Head of claims and legal at EthiQal JP Ellis says: “Legal action should be a last resort, pursued only after all other channels of communication and conflict resolution have been thoroughly explored. It’s essential to recognise that litigation is not only costly but also time-consuming, intricate, and emotionally draining for both parties involved.

“By fostering open dialogue and understanding between patients and healthcare professionals, we can mitigate unnecessary legal proceedings and uphold the integrity of our healthcare system.”

Other than the undue stress it causes to both the patient and doctor involved, unwarranted legal action creates unnecessary bottlenecks within the regulatory processes, potentially slowing down the review of deserving cases. While the HPCSA has acknowledged the delays and inefficiencies within their processes, they are actively dedicated to making significant improvements.

Ellis adds: “Medical care cannot guarantee perfect outcomes and it is important to understand that it inherently involves certain risks. It is essential to recognise that less-than-ideal outcomes or unexpected complications do not automatically indicate negligence.

“Our courts have cautioned against the natural human inclination to attribute blame to someone when an innocent party is injured. This underscores the importance of distinguishing between adverse outcomes and genuine negligence.”

And Makuluma adds: “Doctors’ Day is an opportunity to recognise the growing challenges facing South African doctors. It is also an opportunity for each of us, as patients, to foster open and direct communication with our doctors to safeguard a robust healthcare system in our country.”

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1. Annual report
2. An inquiry into a complaint or charges brought against the registered healthcare practitioner by the relevant Professional Board under the Health Professions Act and its regulations.
3. A preliminary investigation of complaints to make a determination thereon in terms of Section 15(5) of the Health Professions Act.
4. The Medical and Dental Professions Board is constituted in terms of the regulations relating to the Constitution of the Medical and Dental Professions Board contained in Regulation No. R 1254 of 28 November 2008.

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