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Why Sick Doctors Make Mistakes - Dr Mark Burgin

24/12/24. Dr Mark Burgin considers the pattern of errors made by doctors who are suffering from sickness and what steps can be taken to avoid patient harm.

It has been suggested that all doctors make three mistakes a day, good doctors know that they have made the mistakes, bad doctors do not. In this article I consider what the effects of having an estimated 50% burnout rate might have on the types of mistake a sick doctor may make, their response to their errors and what can be done to reduce the harm.

There are an estimated 800k clinical errors in the UK per year, the current system of clinical negligence only identifies about 1% of these errors. The reasons for the poor performance is threefold.

  • Lawyers lack understanding and flexibility when addressing doctor mistakes.
  • The Bolam principle means that most doctors who make a mistake have a defence.
  • Bad behaviour is inadmissible as evidence that a doctor has made a mistake.

The effect of sickness on medical errors is that the chance of causing harm is significantly increased. Most doctors are aware of the errors that they make and work to detect those errors and put them right. A surgeon who knows that they often perforate the bladder will look for the perforation and repair it as a standard part of their care, when they become sick they stop looking for perforation.

Test for doctor sickness

The first test for doctor sickness is to ask a question about the diagnosis or treatment. Something simple such as how effective is the treatment or what is the chance that something will go wrong. A well doctor will explain the risk in a reasonable way making it clear that there is uncertainty. A sick doctor will be dismissive saying that they are certain about the diagnosis and the treatment will not go wrong.

The second test is to make a minor complaint about the service or explanation. A well doctor will engage with the complaint and may even question if the patient is struggling. A sick doctor will take it personally and become hostile and difficult.

The third test is ask about the doctor’s experience and ability to do the task. A well doctor will give a fair description of their CV give examples of where others might rely upon their work. A sick doctor will ask the patient whether they want to be referred to another doctor.

These three tests have proved to be reliable in detecting those doctors who are struggling. Doctors should be able to answer questions about the illness, they should be able to accept that mistakes happen and they should have an idea of whether they have the right qualifications to do the treatment.

Types of errors

The main error that occurs is a simple mistake, the wrong diagnosis, the wrong treatment or the wrong test. In general these errors do not cause real harm because the doctor has another chance to get things right. Often the error is picked up when explaining to the patient who corrects the doctor and the mistake is identified.

Misunderstanding is very much more common with sick doctors, they struggle to use communication effectively. They may have inappropriate emotional responses to the patient’s feedback or get irritated and not listen properly. Patients are often aware of the misunderstanding but may be put off from further attempts to clarify.

Poor engagement is again a common pattern seen in sick practices. Often the patient bounces back and forward without their problem even being properly documented. This is more common in practices with multiple levels of barrier such as triage, non doctor health professionals and telephone consultations.

Reasonable adjustments

As the majority of doctors are likely to be impaired due to sickness such as burnout it is not possible to withdraw all sick doctors from front line care. Simple steps such as reducing their responsibilities for supervision of non doctor health professionals also seem blocked. In primary care for instance most contacts are with pharmacists, paramedics, physician associates, nursing prescribers etc. all of whom need better rather than reduced supervision.

Properly funding administrative support or even allowing all the 62k fully qualified GPs in the UK to provide care rather than limiting it to 27K would help. The resistance to both these steps is intense but the medical leadership should recognise that they are necessary. GPs are becoming snowed under with paperwork and this increases their complexity burden. Difficult to manage when well, impossible when sick.

Private care is often used by patients to reduce the stress on their doctors. This can be arranging a private scan that would have taken weeks or months on the NHS. Or getting a second opinion from a consultant when the local ‘pathway’ is staffed by Foundation year doctors and specialist nurses. The sick doctor may not be able to cope with trying to solve the problems with broken systems.

Conclusions

Sick doctors are the norm in the UK health system and it seems unlikely they do not make more mistakes than well doctors. Their sickness damages the systems to prevent their mistakes from harming patients and reasonable adjustments are often unavailable. Legal systems to protect patients are almost useless and complaints systems are bureaucratic and slow.

It has been joked that it would be quicker to fly to Turkey to see a doctor than to wait in the UK A and E departments. In Turkey they seem to address a problem in a single consultation that takes 10 in the UK. The sick doctor is not an efficient doctor even if NHS ran smoothly which it does not.

As medical leaders, managers, lawyers, reasonable adjustments, increased funding and staffing have made little or no difference it is for the patient to solve the problem. They should identify the sick doctor and take steps to avoid suffering harm from their mistakes. They should go privately to ensure that they get prompt tests and a second opinion but not spend thousands on a fully private service.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is a Disability Analyst and is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 websites drmarkburgin.co.uk and gecko-alligator-babx.squarespace.com

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

Image ©iStockphoto.com/LaylaBird

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The opinions expressed in the articles are the authors' own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand. 

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