From Discipline to Quality of Care: How Neurologists Can Learn from Decisions of Disciplinary Tribunals

Abstract

Background: One of the primary aims of medical disciplinary law is to improve the quality of care. However, the decisions of disciplinary tribunals are not sufficiently analysed to identify the learning elements.

Aim: This study aimed to investigate the frequency and nature of complaints for the specialty neurology which were upheld by the disciplinary tribunals and to learn from disciplinary law through an analysis of which factors contributed to complaints being upheld.

Design: This is a retrospective, observational study.

Methods: All upheld complaints in the field of neurology were collected for the period of January 1, 2010, to January 1, 2020. A qualitative analysis of the decisions was conducted using the usual characteristics set out by disciplinary tribunals in their annual reports. The relevant factors which potentially played a role in the complaint being upheld were identified for more detailed analysis.

Results: In the 10-year period, a complaint was submitted to the disciplinary tribunals against 299 neurologists. Forty-four complaints were upheld (15%). The most common sanction was a warning (70%). A large majority of cases were directly related to patient care, such as decisions about the patient's diagnosis and the treatment. Recordkeeping (50%), interpretation and discussion of imaging (30%), and involvement of several consultants of one or more specialties (34%) frequently played a role in the successful complaints.

Conclusion: Medical disciplinary cases in the field of neurology are usually about diagnosis- and treatment-related aspects. Recordkeeping, interpretation of neuroimaging, and involvement of several consultants frequently play a role in a complaint being upheld. It is important that specialties evaluate disciplinary decisions on a structural and continuous basis.

Keywords: Disciplinary tribunals; Evaluation; Lessons; Neurology; Quality of care.