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

<b><i>Background:</i></b> 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. <b><i>Aim:</i></b> 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. <b><i>Design:</i></b> This is a retrospective, observational study. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusion:</i></b> 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.

<b><i>背景：</i></b> 医疗纪律法的核心目标之一是提升医疗护理质量。然而，目前针对纪律审裁庭的裁决开展的分析尚不充分，难以从中提炼可借鉴的学习要点。<b><i>研究目的：</i></b> 本研究旨在调查神经科专业领域内被纪律审裁庭认定成立的投诉的发生频率与具体类型，并通过分析导致投诉成立的相关因素，从医疗纪律实践中汲取经验。<b><i>研究设计：</i></b> 本研究为回顾性观察研究。<b><i>研究方法：</i></b> 收集2010年1月1日至2020年1月1日期间所有神经科领域的成立投诉案件。依据纪律审裁庭年度报告中列明的常规特征，对案件裁决文书开展定性分析，并提取可能影响投诉成立的相关因素进行深入剖析。<b><i>研究结果：</i></b> 在本次10年研究周期内，共有299名神经科医师被提交投诉，其中44起投诉最终成立（占比15%）。最常见的惩戒措施为警告（占比70%）。绝大多数案件直接涉及患者护理工作，例如患者的诊断与治疗决策。病历记录（占比50%）、影像解读与讨论（占比30%）以及涉及多个专科的多名会诊医师参与（占比34%），常为导致投诉成立的关键因素。<b><i>研究结论：</i></b> 神经科领域的医疗纪律惩戒案件通常围绕诊断与治疗相关事项展开。病历记录、神经影像学解读以及多名会诊医师参与，常成为投诉成立的诱因。各专科应系统性、持续性地对纪律审裁庭的裁决开展评估工作。