Complaints Against Family Physicians Submitted to Disciplinary Tribunals in the Netherlands: Lessons for Patient Safety

Sander Gaal; Chantal Hartman; Paul Giesen; Chris van Weel; Wim Verstappen; Michel Wensing

doi:10.1370/afm.1308

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Table 1

Description and Number of Complaints (N = 250)

Type and Example of Complaint	Complaints	Complaints With Physician at Fault	Complaints With Serious Health Outcomes	Complaints With Serious Health Outcomes and Physician at Fault
Wrong diagnosis: allowing cycling, when a hip fracture was diagnosed later; diagnosing influenza in a patient with meningitis	60	27	33	18
Insufficient medical care: family physician diagnoses myocardial infarction but does not stay with patient until ambulance arrives, and patient dies of cardiac arrest before ambulance arrives. No referral to a urologist in a male patient with recurring urinary infections	54	20	17	11
Wrong treatment: giving amoxicillin to a patient with known allergy; wrong type of lithium	23	6	6	2
Referral too late: missing of a malignancy (metastatic) in a patient with lower back pain; missing of a breast carcinoma	18	4	4	3
Incorrect statement or declaration: family physician gives an incorrect statement to the police about violence within a family; family physician gives incorrect information about the husband in a child abuse case	15	8	0	0
Violation of privacy: family physician notes down medical information about patient in letter to her ex-husband; family physician gives the medical record to a family member without permission	14	9	0	0
Not showing up, or too late at a house visit: family physician refuses a house visit for a patient with (as later shown) a stroke; family physician refuses a house visit because patient lives too far away	14	2	6	1
Insufficient information: eg, family physician did not give information about side effects of corticosteroid; family physician refuses to talk to a patient	6	3	1	1
Impolite behavior: family physician refuses to lift fallen patient, fire department had to come; family physician shouts at a patient	5	2	0	0
Inappropriate contact with patient: sexual relationship with a patient	2	2	0	0
Wrong billing: patient found billing too high	1	0	0	0
Other	19	5	7	1
Impossible to identify the type of complaints	19	0	0	0
Total	250	88	74	37

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The Article in Brief

Complaints Against Family Physicians Submitted to Disciplinary Tribunals in the Netherlands: Lessons for Patient Safety

Sander Gaal, and colleagues

Background It is important to identify and learn from patient safety incidents in primary care. One approach may be to examine complaints against family physicians submitted to Dutch disciplinary tribunals, which offer patients the opportunity to file complaints against doctors outside a legal malpractice system and without possible financial compensation. This study analyzes 250 such complaints submitted between 2008 and 2010.

What This Study Found Complaints covered a wide range of topics, with wrong diagnosis (44%) and insufficient medical care (23%) most prevalent. In 74 cases, a serious health outcome occurred; 37 of these were assessed by disciplinary tribunals as avoidable harms.

Implications

Analysis of disciplinary verdicts may be an appropriate method to identify and analyze incidents with serious health outcomes. Their representativeness, however, is unknown.
In this study, most incidents with serious health consequences were diagnosis related. Although risks cannot be completely avoided, the authors suggest that patient safety programs in primary care increase their focus on diagnostic procedures.