Doctors urged to do more listening as complaints about care increase

Medical professionals can prevent up to 80 per cent of cases by spending a few more minutes with their patients, officials say

Poor communication by doctors is being blamed for a rise in complaints about healthcare. Despite a new medical negligence law coming into force in 2008, only a handful of cases reach court, as most complaints involve miscommunication rather than negligence or malpractice.

Officials say up to 90 per cent of complaints stem from misunderstandings between doctor and patient and, as a result, unrealistic expectations. Dr Jamal al Kaabi, a senior investigator at the Health Authority-Abu Dhabi (HAAD), said doctors should be aware that quality care ran in tandem with good communication. "If a physician would allow just five more minutes of his time to listen to concerns properly, it would solve around 70 or 80 per cent of the problem," he said.

A survey in Abu Dhabi last year revealed that doctors spent an average of only eight minutes with patients, barely half the recommended international standard of 15 minutes. A team at HAAD said the time "was not sufficient to ensure adequate patient counselling and care". The number of complaints to HAAD's 800 800 telephone number last year rose by more than 20 per cent on 2008, from 178 to 219. These complaints are then divided into those about the service received by patients and those involving clinical issues.

If the complaint is service-related, HAAD contacts the hospital, clinic or management body to discuss ways of fixing the problem. In clinical cases, a team in the authority investigates, sometimes with the involvement of an independent external reviewer in the United States. In those cases, Dr al Kaabi said, "everything would get sent to the United States and they provide us with a comprehensive report that concludes with 'the treatment was in standard care' or 'deviated from standard care'."

He did not say, however, how many cases have been sent to the US. Once the patient has been told of the investigation's findings, he or she has the right to pursue a criminal or civil case, Dr al Kaabi said. It is only the courts which can issue compensation rulings. If the authority deems it necessary, it may send a file to the court to be examined under the medical negligence malpractice law. The Dubai Health Authority (DHA) also plans to streamline its complaints procedure, according to Dr Ramadan Ibrahim Mohamed, the director of regulation at the authority.

He said the 2008 medical negligence law has "made it clear about the patient's rights and clarified medical negligence and malpractice. It gave us a better idea of how to handle complaints". He said the DHA was studying "the whole medical complaints procedure" and would schedule workshops for medical practitioners. Complaints received by the DHA are similarly split into service and clinical problems.

The latter are reviewed by a clinical committee within the authority and then by a separate legal committee to see whether any criminal or civil case should be taken to the courts. The DHA can issue licensing penalties but does not take legal action itself. However, it could pass a case to the public prosecution if appropriate, Dr Mohamed said. The DHA did not reveal information on the numbers of complaints or court cases involving medical professions.

However, Dr Mohamed agreed that most complaints were based on miscommunication rather than clinical errors. "Around 80 or 90 per cent of complaints are communication problems," he said. "Either the professional doesn't explain to the patient full details or the consequences of a procedure or test, so the patient may think a complication is a clinical error." Like HAAD, the DHA has also seen an increase in complaints over recent years.

Dr Mohamed put this down to increased awareness among patients rather than a drop in quality of health care. He said patients and doctors needed to be more aware of what qualified as a genuine medical complaint. "We need to really clarify the difference between a medical complaint and an administration complaint," he said. "More documentation will make sure that everyone is aware of their rights. It means more transparency."

Before the 2008 law, health-related legal cases were covered by two separate laws, neither of which specifically related to medical negligence, according to Omar al Shaikh, a partner at the Dubai-based legal firm Hadef & Partners. "The law of tortious liability and the gross negligence law were the only two avenues for prosecution in medical liability cases," he said. Tortious liability cases cases involving breach of duty contained in a contract were dealt with by the civil courts, according to Mr al Shaikh, while gross negligence cases could be lodged with either the civil and criminal courts.

Although the 2008 law specifically addressed medical cases for the first time, it was criticised at the time of its introduction. Doctors and hospitals said it was too vague and not detailed enough to cover so many complex topics, such as criminal negligence, patient consent and confidentiality. Only a handful of successful prosecutions have come under the law. In November, a Ukrainian woman became the first person to be jailed under a new federal malpractice law after her failure to provide adequate care led to a baby suffering brain damage.

She was jailed for a year and fined Dh10,000 (US$2,700) after the Abu Dhabi Court of Misdemeanors found that she had been practising without a licence. A father and HAAD filed separate cases against her and the hospital. The hospital was also fined Dh10,000 for knowingly employing her and for failing to provide the necessary equipment for delivery. Dr al Kaabi would not comment on the law, beyond saying it was better than having "no law at all".

@Email:[e-mail] With additional reporting by Awad Mustafa