I remember the email landing in my inbox. ‘Action required: Serious incident review.’
I was really shaken. I had never received anything like this before. The incident related to a complex case I'd been peripherally involved in as a foundation doctor where the patient ultimately died. Later, I realised some 20 other doctors had also been asked to submit statements and it was a routine process, but at the time I didn’t know this and felt singled out.
I was doing locum work in a different trust when I received the email, so felt particularly isolated and unsure where to get advice. I had received very little training on how to prepare a formal statement but on the advice of a senior colleague, I went back to my old trust and requested the patient notes so that I could write my statement. I also got in contact with my old supervisor to seek their advice and prepared a factual statement in line with advice on the MDU website. My old supervisor then provided some critique and reassured me that I’d done nothing wrong, so would not need to contact my defence organisation.
Despite this consolation, I felt incredibly anxious. I lost sleep and worried about all the potential what ifs: what if I had missed something? What if I had to give evidence when it went to the coroner’s court? What if the patient’s family held me responsible? At work I started to doubt my decision making and noticed I was asking for senior opinions more frequently. Where I had once enjoyed the fast pace and high acuity work of the emergency department, I started to fear it and see the potential for errors in every patient contact.
Although I recognised this loss of confidence, I didn’t know who to turn to for support. I felt embarrassed to talk to my peers as none of them had mentioned an experience like this. I was scared to contact my defence union in case doing so suggested I was at fault – and after all my supervisor said I didn’t need to. I realise now this was wrong.
Getting expert objective advice at an early stage would’ve gone a long way to quell my anxiety.
Opportunity to reflect
It was only when I started GP training that I began to reflect on the experience and rebuild my confidence. I had a very supportive supervisor who listened to me talk about the incident and the impact of the subsequent investigation process. This was the first opportunity I’d had to fully debrief with someone impartial. We discussed how I could’ve approached things differently and they encouraged me to think about what I could take from the experience to make me a better clinician in the long run.
The first thing we concluded was that I should’ve contacted my defence organisation. While local senior clinician advice is usually very good and has an important role, it lacks the medico-legal expertise and impartiality of a trained adviser. MDU advisers are themselves clinicians, and deal with these situations every day, so they can check any statements thoroughly and give clear information about what to expect and the gravity of the situation. Getting expert objective advice at an early stage would’ve gone a long way to quell my anxiety.
Photo credit: iStock
Secondly, the experience had a massive impact on my wellbeing and on my work, but I didn’t seek any support. I now know there are several sources of support I could’ve accessed – such as NHS Practitioner Health, BMA counselling services and more. However, the onus is very much on the doctor to recognise the need for support and reach out.
In terms of moving forwards, I learnt some valuable lessons. Trying to prepare a statement some time after the event highlighted how important thorough documentation is. I now prioritise contemporaneous documentation even on a busy shift because this isn’t something that can be safely delegated or delayed. With experience, I’m becoming more efficient at this and am confident I’m getting the level of detail right.
Since then, I’ve been fortunate enough to use my experience to help improve the support experience for others. By complete chance, an opportunity to work with the MDU and the Healthcare Leadership Academy on how to better support clinicians through medico-legal processes came up during my scholarship year. Alongside two other scholars, we surveyed more than 700 doctors on the impact of complaints.
Most respondents felt the complaint against them had a significant impact on both their personal (92.1%) and professional (94.8%) lives. Interestingly, trainee doctors felt the least supported – this seemed to stem from it being their first experience and a lack of training on dealing with complaints. To tackle this, we’ve been working with the MDU to develop:
The most challenging issue is the stigma around complaints, medico-legal processes and accessing the necessary support. This was particularly notable among more junior clinicians who responded to our survey – indeed, none of the foundation doctors had contacted their defence organisation when faced with a complaint. The reasons given for not reaching out echoed some of my own:
- belief the issue was not serious enough
- reassurance in that they were only minimally involved
- fear it could formalise their involvement
- fear it could be viewed as an admission of guilt.
From my work with the MDU, I’m now in a position to bust some of these myths, which I too had believed.
- No issue is too small to get advice on.
- It is always recommendable to get professional advice if you’re involved in any formal process.
- Getting medico-legal advice in no way implies liability.
Giving medico-legal advice is why defence organisations exist, so don’t hesitate to get in touch at any stage of your career. To support your wellbeing from an early stage, the adviser can link you in with the new MDU peer support network. They can also signpost you to a range of educational resources to help you and your team learn from the incident and turn it into a positive.
I hope that promotion of our work and the holistic support resources we’ve created will grow the conversation around medico-legal processes – how common they are and the impact they can have – so that all medical students and clinicians feel comfortable to come forward for advice and support when they need it.
Medico-legal adviser Dr Edward Farnan on what to do when things go wrong.
It’s natural to feel anxious or even ashamed when you receive a complaint or are notified about a clinical incident. The initial focus will often be on providing a response in the hope that this will resolve the concerns.
As a result, the impact on the individual clinician can easily be forgotten. The concept of the ‘second victim’ is well recognised, particularly when it comes to incidents resulting in patient harm, as is the need for doctors and students to feel supported when something has gone wrong.
A just and learning culture within organisations may help with this, as can support from colleagues, friends, family and others – including your defence organisation.
What to do when you receive a complaint
While it may be upsetting to receive a complaint, it’s also important to respond appropriately. This is consistent with GMC guidance.
Discussing the complaint with colleagues and supervisors and reflecting on these discussions also forms an important part of the appraisal and revalidation process for all doctors and is a good opportunity to learn and develop.
- The first step, on receiving a complaint, is often to review the complaint in detail to identify the individual concerns, particularly when it comes to your involvement in the case. It can then be helpful to review the contemporaneous records and any other relevant correspondence to see what exactly happened at the time.
- You can then prepare a factual account of events before addressing the specific concerns raised. It’s generally appropriate to include evidence of reflection or learning when responding to concerns – and an apology if appropriate.
- A thoughtful, measured and reflective response to a complaint will often result in the matter being resolved at the earliest opportunity without it escalating. It will also help to protect your interests in the event of the complainant remaining dissatisfied.
- We can help review and comment on your draft response before you submit that to your employer. Find more information about how we can help and how to contact us.
Dr Laura Hulmes
Laura is a Newcastle University Medical School graduate and is now working as a GP trainee in the north east of England. She has interests in population health, health inequalities and leadership in healthcare. Outside of work, Laura likes to travel (COVID-permitting) and to spend time with her friends, family and pet cats.
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Dr Edward Farnan
Dr Edward Farnan
MB BCh BAO LLM FRCGP DGM DCH DRCOG
Dr Farnan graduated from Queen's University, Belfast, in 1995 and completed his GP training in Northern Ireland, practising as a principal in general practice in Armagh for 11 years. He also sat on a research ethics committee, and had a particular interest in clinical governance.
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