Residency is a time of intense learning, long hours, and high expectations. Resident physicians face unique challenges as they strive to deliver safe care to their patients, while building their medical knowledge and skills. But what happens when a resident is faced with a patient complaint?
There is significant research on the mental and physical impact of medico-legal complaints on physicians, which can result in heightened risks of depression, anxiety, and suicidal ideation. There is, however, little to no data available about the toll complaints can take on residents, who are still forming their professional identities.
Canadian Medical Protective Association (CMPA) researchers sought to determine how the experience of a medico-legal complaint might differ for residents. They conducted and analyzed interviews with 35 physicians across various specialties and at different career stages, all of whom had received patient complaints during their residency. Participants were asked to share how the experience affected their self-perceptions and professional lives.
This study, published in the Association for the Study of Medical Education journal, Medical Education, is the first to examine the emotional toll of these events on residents and whether they affected career paths. The study has the potential to positively impact how residents are supported through medico-legal events as well as the ongoing support and training they receive during this particularly intense period of the physician’s career.
The Emotional Journey—Turning Points
Although most physicians will experience a patient complaint at some point in their careers, these events can be very jarring. Complaints can trigger feelings of shame, isolation, and self-doubt. During the interview process, many of the participants expressed a feeling of shock when asked to recall the impact of a complaint during residency:
“I was completely blindsided. A complaint was not expected at all. I didn’t have any kind of bad interaction with the patient, I didn’t have … it came out of nowhere.”
Residents often described feelings of distress and isolation. They began to question their ability as a physician:
“I felt like I didn’t deserve to be a resident. I wasn’t a good physician. I couldn’t be trusted. Patients weren’t safe in my hands.”
Several physicians explained how the experience impacted decisions about specialty choice:
“I think it probably steered me away from getting more training in emergency medicine. It probably did have that effect.”
Several participants described how the emotional journey became a turning point in their career, which led them to change how they practice medicine by adjusting their documentation practices as well as their approach to patient care:
“I make it a point now to document not just the facts, but also how the patient responds—ensuring there's a clear trail of their acknowledgment and engagement.”
Others spoke about mentoring younger colleagues, hoping to prepare them for similar challenges:
“By sharing my own experiences, I aim to equip my residents with the knowledge to better handle similar situations.”
The Hidden Toll of Complaints
A medico-legal complaint can be seen as taboo, often resulting in a physician questioning their professional identity. Physicians pride themselves on providing what they believe is the best possible care for their patients. Many may see a complaint as a failure, and that is the last thing a physician wants to do—fail their patient.
Importantly, this research illustrates how physicians who receive no support can struggle and how a medico-legal complaint can impact them for a very long time. In contrast, physicians who receive support are more capable of looking at the experience in a constructive way and grow from it.
Recommendations: Supporting Residents Through Complaints
This research can give physicians who supervise residents a new understanding of how medico-legal events can impact residents’ mindsets and identities. It can help to destigmatize patient complaints by enabling residents to talk about their experiences, normalize these feelings, and hopefully encourage them to reach out for support.
CMPA’s study highlights the need to better support residents facing complaints. It can help institutions and training programs to foster environments where patient complaints are destigmatized through the development of education and support systems for residents that are involved in medico-legal complaints.
How CMPA Provides Medico Legal Advice and Supports Physicians in Canada
CMPA provides a range of support services to its physician members. Anchoring those services are more than 60 physician advisors (PAs), who come from a range of specialties and have acquired at least 10 years of clinical experience before joining CMPA. PAs also undergo significant training and coaching before assisting a member. So, when a resident calls, we can assist them with empathy, because PAs understand that a complaint can be devastating.
Earlier this year, the CMPA launched the Physician Well-Being Index, with a module specifically geared for residents, to assess and track their level of well-being. The tool provides region-specific resources tailored to their needs, depending on their level of distress.
In addition, a free, interactive virtual workshop, CMPA’s Patient Safety Primer, is offered to residents at all stages of learning, which covers medico-legal topics frequently encountered by residents as illustrated through CMPA case files.
Turning Data into Research and Learning
In supporting physicians from across the country, CMPA collects and maintains medico-legal data, the largest collection of its kind in the world. These data uniquely position CMPA to conduct important research to foster system change and improve patient safety. Through these research efforts, CMPA publishes risk management articles in peer reviewed journals, and develops resources as well as practice improvement learning opportunities for doctors.
Empowering Better Healthcare
CMPA seeks to empower better healthcare through the delivery of efficient, high-quality physician-to-physician advice and assistance in medico-legal matters. CMPA also provides appropriate compensation, on behalf of our members, to patients proven to be injured by negligent medical care. Our peer-reviewed research results in evidence-based products and services focused on enhancing patient safety and reducing patient harm.
As Canada’s largest physician organization and with the support of our 117,000+ physician members, CMPA collaborates, advocates, and effects positive change on important medico-legal issues.