A recent study conducted at Imperial College London has revealed that doctors who go through a complaints process or an investigation by the General Medical Council (GMC) suffer from anxiety, depression, and even suicidal thoughts. Doctors who face complaints or even doctors who see colleagues in this situation undoubtedly change the way they treat their patients, and not for the better.

"Of course it's essential that when things go wrong, the reasons are properly investigated," Professor Tom Bourne, lead researcher from the Department of Surgery and Cancer at Imperial College London, said in a statement. "But this study suggests that the regulatory system we have in the UK has unintended consequences that are not just seriously damaging for doctors, but are also likely to lead to bad outcomes for patients. We think this needs to be looked at carefully by policy makers."

Bourne and his colleagues gathered data using a survey of 7,926 doctors. The GMC, which regulates doctors in the UK while either terminating or limiting their right to practice medicine, received over 8,500 doctor complaints back in 2013, around 3,000 of which were investigated. In the UK, around 80 doctors a year are suspended or have their medical license revoked.

Doctors participating in the survey were twice as likely to suffer from moderate to severe anxiety and twice as likely to consider self-harm if they were recently the subject of a complaint. If that complaint was brought to the GMC, doctors often experienced more serious psychological complications, including 26 percent of doctors who reported moderate to severe depression and 22 percent who reported severe anxiety.

An internal review published by the GMC back in December highlighted 28 cases of suicide by doctors who were investigated. The GMC found that the investigation process can “create a culture of fear and discrimination,” and that doctors undergoing the process need to feel “innocent until proven guilty.” Twenty percent of doctors from this survey felt they were victimized after whistleblowing, and 39 percent felt bullied during the investigation against them.

Fear over an investigation often led doctors to practice defensive medicine — even doctors who had not undergone an investigation but had witnessed their colleague deal with the complaint process. Among both doctors who were subject to the complaints process and colleagues who witnesses it, 84 percent admitted to overprescribing, referring too many patients, or ordered unnecessary tests. Forty-six percent were reluctant to treat difficult patients or perform difficult procedures.

"A key issue that has come out of the study is the apparent impact on patient care of these complaints processes," Bourne added. "Overprescribing or referral and avoiding complex patients or difficult operations because of a fear of complaints or the actions of the regulator is clearly not in the interests of patients, and may increase costs to the NHS. We need a new structure that is transparent, fair, and has the confidence of all parties."

The fear of malpractice litigation also affects doctors in the U.S. According to the American Academy of Orthopedic Surgeons, “positive defensive medicine” refers to ordering additional tests or procedures, and “negative defensive medicine” refers to avoiding high-risk patients or procedures. A total of 500 physicians, nurses, and hospital administrators participating in a recent survey revealed that over 76 percent of physicians reported that malpractice litigation had diminished their ability to provide quality care to patients.

Source: Bourne T, et al. The impact of complaints procedures on the welfare, health and clinical practice of 7,926 doctors in the United Kingdom: a cross-sectional survey. BMJ Open. 2015.