Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims, or impaired performance

Elizabeth E. Austin, Vu Do, Ruqaiya Nullwala, Diana Fajardo Pulido, Peter D. Hibbert, Jeffrey Braithwaite, Gaston Arnolda, Louise K. Wiles, Tahlia Theodorou, Yvonne Tran, Reidar P. Lystad, Sarah Hatem, Janet C. Long, Frances Rapport, Annette Pantle, Robyn Clay-Williams

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)
20 Downloads (Pure)


Objective To identify the risk factors associated with complaints, malpractice claims and impaired performance in medical practitioners.

Design Systematic review.

Data sources Ovid-Medline, Ovid Embase, Scopus and Cochrane Central Register of Controlled Trials were searched from 2011 until March 2020. Reference lists and Google were also handsearched.

Results Sixty-seven peer-reviewed papers and three grey literature publications from 2011 to March 2020 were reviewed by pairs of independent reviewers. Twenty-three key factors identified, which were categorised as demographic or workplace related. Gender, age, years spent in practice and greater number of patient lists were associated with higher risk of malpractice claim or complaint. Risk factors associated with physician impaired performance included substance abuse and burn-out.

Conclusions It is likely that risk factors are interdependent with no single factor as a strong predictor of a doctor’s risk to the public. Risk factors for malpractice claim or complaint are likely to be country specific due to differences in governance structures, processes and funding. Risk factors for impaired performance are likely to be specialty specific due to differences in work culture and access to substances. New ways of supporting doctors might be developed, using risk factor data to reduce adverse events and patient harm.

PROSPERO registration number PROSPERO registration number: CRD42020182045.
Original languageEnglish
Article numbere050377
Pages (from-to)1-25
Number of pages25
JournalBMJ Open
Issue number8
Publication statusPublished - 24 Aug 2021

Bibliographical note

Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • clinical governance
  • health & safety
  • health policy
  • human resource management
  • risk management


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