Crammer’s Corner. Complaints: Managing the complaint and oneself

Complaints are an inevitable part of a doctor’s professional life. It can be extremely stressful to discover that a patient you thought you treated well has chosen to make a complaint about you. Although the gravity of complaints varies, they can all cause stress and anxiety. This article by Dr Kunal Chawathey looks at some basic principles when dealing with patient complaints.

No one likes to be at the receiving end of a complaint. However, given that an average GP has about 41 patient contacts per day, it is inevitable that at some point something will not go right, and the result – a dreaded complaint letter sitting in your box amidst a pile of script queries and medical forms. Statements from doctors about the complaints include phrases such as, ‘It makes you feel worthless even when you know you've done the best you can’, highlighting the impact of complaints on one’s self-esteem. This article focuses on how a trainee (and indeed any clinician) can deal with personal feelings while formulating an appropriate response to a complaint. Indeed, there might be a scenario in your clinical skills assessment (CSA) where a patient or relative has booked an appointment to complain about a colleague.

Just received a complaint …

Remember that the majority of complaints are the result of misunderstandings and unfulfilled expectations that can easily be resolved within the practice. It is however, human nature to immediately discount the positive and believe in the negative. As a full-time trainee in general practice you will have about 70–90 patient contacts per week. If you do have a complaint during your placement, it is important to take a step back and reflect that out of a few hundred patients seen, only one person has complained. All the others were probably quite grateful for your help.

It is normal to feel a degree of panic (more or less, depending on how you are wired) and to begin catastrophising on reading the letter of complaint. If this happens during your clinic session, ensure that you take some time out to calm down. It is okay to contact your supervising clinician (or your trainer if he/she is within the premises) and speak to them. It can help to get a different perspective of the complaint. Your supervising clinician will be aware that you will feel stressed and can keep a closer eye on you through the rest of the day.

Complaint letters often mirror the unfulfilled expectations of patients and can offer an opportunity to improve on the quality of care. When you receive a formal complaint:

You should discuss the complaint with your trainer or clinical supervisor, as well as with your medical defence organisation (MDO)

The Duty of Candour

The Duty of Candour is a statutory duty to be open and honest with patients or their families when something goes wrong. It applies to all health and social care organisations registered with the Care Quality Commission. Point 61 of Good Medical Practice advises doctors to respond promptly, fully and honestly to complaints and to apologise when appropriate. You must not allow a patient’s complaint to adversely affect the care or treatment you provide or arrange.

Writing a factual statement

You may be asked to provide a factual statement if multiple clinicians are involved or if the practice complaints lead is taking responsibility for formulating a response. If the complaint has not come to you directly, ask to see the complaint letter and relevant medical records – this is key if you are in a peripatetic service provision role (e.g. training in a rotation or working as a locum doctor) or no longer working at the surgery. When providing a factual statement, highlight details within your account that are based on memory, contemporaneous notes or your ‘usual practice’. It is acceptable to mention what your usual practice would be if you are unable to quote from memory.

Writing a response letter

As a trainee, you may be asked to provide a response if the complaint does not involve any other parties or the practice as a whole. Ensure that you involve your MDO when formulating a response. The response should reiterate that you have taken the complaint seriously and express the hope that it will help find a resolution to the complainant’s concerns. The tone of the letter should be sympathetic and professional, with an openness to accepting responsibility wherever appropriate, as well as expressing a desire to learn and change practice based on your reflections. It is important to raise every concern mentioned by the complainant and to apologise for the patient’s grievance. Remember that an apology is not an admission of liability. Section 2 of the Compensation Act 2006 says:

An apology, an offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty.

Ensure that you discuss in detail, your thought process during the consultation in addition to history and examination findings when you are formulating your response. Do not provide an opinion on other colleagues’ actions/inactions in your report. Request them to provide a factual statement of their involvement instead.

House keeping

It is very important to manage your own stress levels and any potential impact on patient care during the complaint proceedings. Stress levels ride high during this period, and as the walls of defence go up you may have a lower threshold for initiating investigations and referrals – which may not be beneficial to your patients.

From a cognitive behavioural perspective, you should reflect on how the complaint may be adversely affecting you and do a quick check for any cognitive distortions, in particular any catastrophising or tendency to discount the positive. It is extremely useful to recognise any unhelpful automatic, negative thought cascades.

One of my registrars had a complaint against her for prescribing an antibiotic that brought the patient out in a mild rash. The patient was not known to have an allergy to the antibiotic, but my registrar was convinced that because she did not document in her notes that skin rashes were a potential side effect, she would be perceived as negligent and ‘quite rightly struck off by the GMC’! A quick review of a few consultations related to antibiotic prescribing provided evidence for her that it is not usual for colleagues to document the possibility of a rash when prescribing antibiotics other than the more specific tetracycline-induced photosensitivity during sunny British weather!

It is perfectly reasonable to see your GP for professional help if a complaint is having an adverse impact on your wellbeing. Another source of help and support is the NHS GP Health Service, a confidential NHS service for GPs and GP trainees in England. It can help with issues relating to mental health concerns, including stress or depression (telephone 0300 0303 300).

Complaints are a good opportunity to build resilience, as well as an opportunity to effect personal and organisational change (Selman, 2015). A healthcare service that listens to patient complaints is able to detect any problems early, and correct them, potentially improving the quality of care provided and protecting future patients from harm.

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