Lessons from complaints investigations

There is a lot that we can learn from complaints and concerns that go to the GOsC. We’re going to look at some of the lessons we can learn today and next week we’ll look at professional development from issues arising within clinic.

The GOsC 2017-18 fitness to practice report has recently been published which gives details of how investigative processes work and cases from the last year. I’m using this report as the basis for this article.

How are complaints investigated

There are three committees that handle complaints at GOsC – the Investigating Committee, Professional Conduct Committee and Health Committee. Here is a brief summary of how the committees work.

When a complaint is received the regulation team at GOsC gather details and then a screener assesses the information. The screener is an osteopath member of the Investigating Committee. The screener decides whether the concern could be considered unacceptable professional conduct and an allegation could be mounted from the Osteopathic Practice Standards. If the screener decides that GOsC has no power to investigate the concern a lay screener reviews the decision.

The Investigating Committee considers whether there is a case to answer against the osteopath. At this stage the case may be closed or there may be a request for additional information or the case will be referred to the Professional Conduct Committee or Health Committee for a hearing.

The Professional Conduct Committee will be a lay Chair, an osteopath and a lay member. Most hearings are held in public. This is like a formal hearing with presentations of facts and evidence and the committee makes a decision and sanction as appropriate.

The Health Committee considers cases where fitness to practice may be impaired due to a physical or mental condition. A medical assessor is also present at these hearings.

Each meeting or hearing is attended by a legal assessor who gives legal advice to the committee.

The GOsC produces a report of each case that is heard by the Professional Conduct Committee.

How many complaints are there?

In 2017-18 the Investigating Committee met seven times and considered 53 cases. Of those cases there was 20 with no case to answer, 10 were adjourned and 23 were referred to the Professional Conduct Committee.

The Professional Conduct Committee heard 45 cases relating to unacceptable professional conduct. The Health Committee considered 2 cases.

Most complaints were from patients, and the second most from the registrar.

Lessons from case hearings

The report provides a summary of Professional Conduct Committee hearings which it considers “a valuable resource for osteopaths on the high standards of conduct and proficiency required to maintain registration as an osteopath.”

I think it is important to note that these cases are just being used to draw lessons from. I do not know the circumstances that led to the situations and am in no way making any comment about the osteopath involved. However, I’m sure those osteopaths would want to sign-post other osteopaths and say don’t go this way, don’t do this and that is what we seek to apply.

There were 7 cases where professional indemnity insurance cover ceased and the osteopaths practised without insurance.

Lesson: Make sure your professional indemnity insurance is always renewed on time. This is simply one of the three non-negotiable responsibilities of osteopaths. The others being registration and CPD.

Another osteopath transgressed professional boundaries by asking questions about romantic relationships and offering relationship advice. Part B of that complaint was that the osteopath failed to respect dignity and modesty by asking a patient to remove jeans face away and bend over to touch her toes. He did not offer a towel or gown.

Lesson: Awareness of scope of practice is important and maintaining professional boundaries is essential to good practice. Dignity and modesty is to be maintained at all times. Be sensitive to patient’s body language and use excellent communication and consent to avoid uncertainty.

Another osteopath made inappropriate comments about other healthcare professionals on a Facebook group chat forum, sent inappropriate comments to someone and provided a diagnosis and advice in a Facebook group without examining the patient.

Lesson: Professionalism is to be maintained at all times – online and face-to-face. The standards state that you are not to damage the reputation of other healthcare professionals. Good clinical procedure is to be utilised in all situations – this includes providing advice and also think about when you attend exhibitions or events.

There was a case relating to treatment of a baby where there was not appropriate aftercare advice provided and on another occasion failing to advise the mother to contact her GP or seek appropriate medical attention.

Lesson: Make sure you always record in your notes advice given to your patients about aftercare and referrals. Include sufficient detail for it to be understood from the record what action the patient was to take.

Another case relates to failure to explain the risks of treatment or obtain valid consent for treatment and using the title Dr misleadingly on their website.

Lesson: Obtaining valid consent is fundamental to good practice. See previous articles for full details.

There is a list of findings against another osteopath – not taking an adequate case history, conduct an adequate examination, formulate an adequate treatment plan, explain the treatment and risks of treatment, obtain valid consent, work appropriately with inferential electrotherapy. This practitioner also put pressure on a patient to purchase minerals and shouted when the patient questioned the cost. He made inappropriate comments about other health professionals and spoke in a lecturing and domineering manner.

Lesson: Always follow a consistent good clinical procedure for your case history, consent, examination and treatment procedures and make sure everything is clearly recorded. Professionalism is to be maintained at all times. If you are stressed, overwhelmed or know you are working at your limits – take time out or seek help.

Lastly there was a case relating to a conviction for driving whilst over the alcohol limit.

Lesson: Professionalism is to be maintained in all areas of your life.

Lessons from the NCOR report 2013-17

This is a report on concerns and complaints with data collected from the insurers, iO and GOsC.

The most concerns and complaints in 2017 were about males (63%) and 10 years of experience (69%). Very few complaints are raised about new graduates practising for less than 2 years.

Concerns about clinical conduct centre on communication – 30% of clinical conduct complaints. 20% were about boundaries.

Clinical care concerns most commonly relate to how treatment is delivered: Treatment inappropriate or not justified, forceful treatment, treatment administered incompetently, treatment causes new or increased pain or injury – 58 concerns.

The NCOR report puts things into perspective – there are around 5300 osteopaths, 184 had a complaint or concern raised against them. There are around 30 000 consultations every working day in the UK.

Communication and boundaries are consistently an area where practice can fall below the standards. In the commentary on the NCOR report there is mention of the potential need for osteopaths to adapt their treatments due to increases in chronic conditions and the aging population – an area perhaps more thought needs to be given to.

Zubin Austin, a pharmacist, has done a lot of research into professional incompetence and he found that people that were at most risk of demonstrating professional incompetence had been in practice for more than 15 years. The lesson is that those who have been in practice for longer must not simply rely on clinical experience but must remain engaged in their professional community in order to maintain their competence levels.

In summary

The lessons we can learn from these two reports on concerns and complaints are that although concerns and complaints are in low numbers for osteopaths there are areas we can improve. Professionalism, boundaries, communication and consent are key areas to ensure you are attaining the required standards.

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