Everyone will receive a complaint – this is inevitable. Usually, these are informal, “I’m unhappy with the care delivered” from a relative or the patient. In this article, I’ll focus on themes contained in Good Medical Practice guidance & Duty of Candour from the GMC, advice from MDU (dealing with your first complaint & how to respond) and MPS. Make sure you read these documents too as they cover the legality aspects.
It is very rare for a complaint to escalate beyond you. Even if it goes to the GMC, most complaints don’t reach the threshold for a full GMC review. Your job is to deal with it if you can, but ideally involve your seniors. They have more experience, understand how hospitals work & can therefore direct the person to the right place. They will want to know as the complaint affects them too as complaints are directed to a team, not a person regardless of what occurred. Additionally, an error is very rarely due to one person – e.g. drug errors are usually due to a prescriber, a pharmacist and a nurse all giving the patient an incorrect medication. The multiple processes have to fail for an error to occur.
The vast majority of complaints are due to communication issues. To safeguard yourself, always aim to document thoroughly & communicate your decisions to the team particularly the nursing staff. They are literally often the most important people in keeping a patient cared for & alive and they coordinate almost everything. Keep them on your side by always letting them know what’s happening as that will often save you from many errors. Countless times a nurse has told me “this doctor has prescribed the wrong thing, can you correct it” and usually they’re right.
You can listen to a complaint from a relative without providing any details that disclose confidential material. However, be careful that you don’t break confidentiality inadvertently. Always check with the patient that you can discuss their case and what they are happy to have shared.
Find out the facts
Go through the notes to find out what happened as this will give clues to the reasons something occurred. It might be that this isn’t the first time this complaint was received, knowing what was said can be helpful. Avoid providing information on something you don’t know – often being an on-call doctor may lead you to provide incorrect information leading to miscommunication which frustrates people greatly.
Be apologetic and supportive
Usually, nothing has gone wrong or the process was not ideal but led to the right outcome nonetheless. Apologising nor offering treatment does not admit liability. Apologising for the frustration and/or that clearly this wasn’t communicated sufficiently is helpful. Always acknowledge that their issue is important regardless of how trivial you feel it is, if they are complaining about it then it is clearly important to them (and therefore should be to you too).
Consider the option of “thank you for raising that & I’m sorry for what had occurred. I would like to review the notes & discuss with my senior colleagues to ensure I’m giving you the most up to date information”. Incorrect or hesitant management of a complaint in the first instance can sometimes lead to escalation, it is best to deal with it properly & once. Have a low threshold to seek support from your consultant and then your defence organisation.
It is easy to get upset and this can affect your ability to care for the patient. If you don’t have the headspace to deal with the complaint immediately because you’re dealing with an emergency or another complex situation – first of all, acknowledge this within yourself. Then take the time to explain to the person complaining something along the lines of above, that you acknowledge their complaint as important and valid but are unable to effectively deal with it right now as you are managing someone unwell but that they should be rest assured you will deal with it properly as soon as you can.
Find out what they know & why the specific issue is so important to them. It is common to find misplaced guilt or an agenda very different from what you expect. Often I’ve dealt with a “why has my mum’s hip fracture been cancelled” which had revealed guilt that the person felt they caused it. Reassure them if possible (and true) that they aren’t to blame for their relative being unwell or that it could’ve occurred regardless of how often they visited etc. Avoid medical jargon or explaining the complexities of processes. For example, don’t say “we are hoping to get your mum to ITU” but instead “we are working on getting your mum the ITU support” or “we’ve escalated to the ITU team so that they can support us in giving her the right level of care”. If you say that their mum needs ITU then they will expect this to occur immediately & don’t appreciate the vagueness of “hoping for” – we know this means we are awaiting that they accept the referral but the layperson doesn’t understand how this works.
Don’t blame a specific person
It isn’t the fault of one specific person so don’t “name & shame”. Take ownership that any issues occurred at the team level. Don’t give names of specific individuals but instead the lead consultant & lead nurse. In the same way, don’t say that you’re the one at fault because it is a team issue. Provide facts based on what occurred and don’t ever give an opinion on what another colleague was thinking or what they did.
Don’t provide notes
Do not provide letters admitting “something occurred” without support from at least your consultant. Do not print out or photocopy any notes. Don’t show anything that exists on the system. Whilst patients are entitled to their own notes, there is a system in place to request this called Patient Advice Liaison Service. Usually, for a small fee, patients can purchase their notes.
It is much more reassuring to the other person if you welcome a complaint and welcome discussions. It is far more suspicious of true wrongdoing if you try to cover up or hide things. Obviously don’t alter notes – but you can always write a new note. Be forthcoming with details of how to contact or find the Patient Advice Liaison Service if they say they would like to complain more formally. Do not encourage them away from this but instead explain that regardless of whether they complain, you acknowledge that it is a serious issue and plan to escalate it via your own internal mechanisms (see below).
Correct what you can & report
Aim to provide a summary that explains how you have dealt with the issue or will escalate the issue to the right person so it can be dealt with. Thank them for bringing your attention to the issue. Inform them that issues are reported – this might be more formally through the incident reporting systems (e.g. datix) or to the rest of the team. In either case, the aim is to improve and strengthen the safeguards to prevent the issue from occurring again. Explain that the outcomes of this aren’t normally communicated to the patient or relatives.
Reflect & learn
When a complaint is received something usually didn’t go ideally. Usually, this is communication rather than something wrong in the patients care or harm to the patient. Every time this occurs take this as an opportunity to discuss with your seniors how to improve your practice, develop a QI project or an alternative to improve practice. For these reasons, consider how serious was the issue (Could it have or did it cause a patient harm? How much harm?) and the risks of it occurring again. This can help identify the best techniques for future improvement.
Written by Dr Akash Doshi (CT2)
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