UK GPs are in general more wary of their patients than their colleagues in other European countries, according to the findings of the latest European Barometer survey. They are twice as concerned as doctors in Italy, France, Germany and Spain that their patients might sue them (see chart right).
They are more likely than overseas colleagues to find themselves the target of verbal abuse from patients. One UK GP in three has been the victim of an actual physical assault by a patient, a rate of patient attack equalled only in France.
The high rate of intimidation of GPs in the UK is revealed in the five-nation survey of GPs carried out by research firm Stethos for GP and leading foreign medical magazines.
An average of 200 GPs responded in each country.
Dr Frances Szekely, a senior medical claims handler with the Medical Defence Union (MDU), said UK GPs were right to be litigation-aware.
'They are right to be worried. There is much less litigation against GPs in most other European countries,' she said.
The situation there is similar to how it was in the UK 20 or 25 years ago, when patients were much less likely to sue their doctors and much less likely to receive high awards.'
Almost half of the UK GPs said that, while treating patients, they habitually thought about the risk of litigation and 13 per cent said that the risk of the patient suing was always at the back of their mind.
In mainland Europe only 21-29 per cent of GPs thought 'often' or 'always' about patients bringing a law suit (see main graph).
Only 3 per cent of UK GPs said that they never thought about patient litigation, compared with 14 per cent in the rest of Europe.
The reasons for the differences between medical litigation rates in the UK and the rest of Europe are multifactorial.
Fear of complaints
One reason is the generous interpretation of what is known in the UK as 'limitation'.
This is where a patient can bring a case against a doctor up to three years after realising that there might be a connection between the medical event and the harm of which they are complaining.
In some European countries, action must be brought within two years of the medical event.
High awards in the UK also fuel litigation, according to Dr Szekely.
Currently awards are increasing at around 5 per cent above the rate of inflation.
Medical negligence awards have been high in the UK because the legislators who framed the Law Reform Act in 1948 decided that anyone who successfully sued for negligence and needed ongoing care should have the award set at a rate that would cover the cost of private care.
Dr Szekely also suggested that some UK GPs in the European Barometer survey may have interpreted the question whether GPs often thought about the risk of 'a possible law suit' more widely to mean 'a possible complaint'.
While the number of claims against GPs is currently stable, Dr Szekely said, complaints to the GMC were rising.
'GMC complaints are rising exponentially. It is possible some GPs who said they were concerned about litigation were actually thinking about some form of formal complaint about their management,' she suggested.
The effect on a GP of litigation or a complaint to the GMC is similar, as both cause 'incredible stress and difficulty', she said.
GMC complaints have been steadily increasing from 1,087 in 1991 to 4,504 in 2001. But since 2001 there has been a slight drop with 4,005 fitness-to-practise complaints in 2004.
UK GPs are also most likely to be shouted or sworn at by their patients, the European Barometer survey revealed.
In the UK, 94 per cent of doctors had experience of verbal abuse and four out of five GPs had been abused more than once.
This compares with average verbal abuse rates in the other of 82 per cent, with 58 per cent of GPs having suffered the experience more than once.
After UK patients, Spanish patients are the most verbally abusive: 88 per cent of Spanish GPs had been subjected to verbal abuse, 70 per cent more than once.
Italians least abusive
Italians are least likely to shout or swear at a doctor. A quarter of Italian GPs have never experienced verbal abuse and of those who have, the experience has been a one-off.
Italian patients were also least likely to have physically assaulted their doctor.
Only 15 per cent of Italian doctors have any experience of patient attack and no more than 3 per cent said they had been repeatedly assaulted.
In view of these findings, it is not surprising that GPs in the UK take among the most days off every year. Mean annual leave in the UK, France and Spain is 31 days, more than 10 days more than in Italy.
Part of the explanation is the meagre supply of public holidays in the UK - just eight days a year, compared with 16 in Italy, 14 in Spain, between 10 and 14 in Germany and 11 in France.
This suggests that UK GPs spend more days working despite the increased stresses of litigation and patient abuse.