Dr Ellie Mein
Complaints from patients are an unfortunate reality of medical practice, and happen to doctors at all levels of experience. Dr Ellie Mein explains the steps to take – and how the MDU can help.
Receiving a complaint at any time in your career can leave the most experienced and confident of doctors feeling upset, but to get one within a couple of years of qualifying can really undermine your confidence.
After years spent at medical school, to find that someone is dissatisfied with any aspect of your clinical care can leave you questioning your abilities and possibly even your career choice.
Feeling upset or anxious after receiving a complaint is far from unusual. A survey published in 2015 by Bourne et al found that complaint procedures can leave doctors emotionally distressed and more likely to practise defensive medicine.
It's often helpful to put negative feedback in context and, considering that NHS Digital reports that during 2016/17 the NHS received 208,400 written complaints, any doctor receiving a complaint is not alone.
What do I do if I receive a complaint?
When you are made aware of a complaint, it is usual that the letter/email or telephone note of the complaint is shared with you and you will be asked to draft a response. Depending on whether the complaint is directed just at you, or at other doctors also, your reply may form the entire letter of response or be incorporated into a coordinated letter with input from other clinicians.
It's also possible that the complaint may come via NHS England or the patient's solicitor.
The NHS complaints regulations give clear time limits on which complaints need to be acknowledged, and in some locations, the time period in which you have to respond. For example, complaints should be acknowledged within three working days in England, Scotland and Northern Ireland and within two days in Wales.
In addition, the trust or practice you are working in will have its own local policy.
The complaints process
This is a two-stage process, and it's good to know that a significant proportion of complaints are resolved locally without reaching the second stage.
However, if a complainant remains dissatisfied after the local resolution phase they have the right to refer the matter on for further review by the Ombudsman. The Ombudsman can make a number of recommendations, including changes to policies and procedures and for a financial redress payment to be made to a complainant by the trust or GP practice, if the complaint is upheld.
Additionally, if a doctor is criticised by the Ombudsman this may require them to consider reporting the matter to the GMC.
A thoughtful and reflective response can be instrumental in early resolution of complaints.
How to respond
While you may feel anxious about responding to your first complaint, by following these five steps, you can maximise your chances of resolving the patient's concerns at an early stage.
1. Get advice from your medical defence organisation promptly.
We can advise you on the process and how to make sure you comply with the required time limits outlined in the complaints handling regulations.
2. Draft your response to the complaint.
In addition to reviewing the complaint, you should also have sight of the relevant records when drafting your response. By reading both, you can be sure that you have addressed all the concerns raised and that your response is accurate and consistent with the records. Include a full description of your involvement and your response to the specific concerns raised. We also recommend that you include details of your reflections on the case. We will be happy to guide you on the content and tone of your response.
Getting this response correct is important, and in the MDU's experience a thoughtful and reflective response can be instrumental in early resolution of complaints.
3. Identify any learning points.
It's important to learn from the concerns raised, so discuss all complaints with your clinical or educational supervisor to identify any possible learning points. This review should look at all aspects of the care provided to an individual by you and your colleagues, good and bad, and does not imply that there was any failure in care.
Identify learning points from clinical management and other aspects, such as documentation or administrative support, which can be used to improve future patient care.
4. Say sorry.
The GMC's guidance says you must be open and honest with patients if things have gone wrong. Additionally, if any patients under your care have suffered harm or distress you should put matters right, where you can, offer an apology and explain fully and promptly what has happened and the likely outcome.
5. Discuss complaints at your annual review.
To meet the GMC's requirements on revalidation you will also need to discuss any complaints you receive at your annual appraisal or training review.
It can be helpful to keep an anonymised record of the complaint, your response, any personal learning points that you identified and what action you took in light of this. You should also keep a copy of the final response for your records.
Keeping an anonymised record of this information in your folder can make preparing for the review less time consuming, and demonstrates that you have responded to any criticisms in a responsible way.
Dr Ellie Mein
MB ChB MRCOphth GDL LLM
Ellie joined the MDU as a medico-legal adviser in 2013. Prior to this she worked as an ophthalmologist before completing her Graduate Diploma in Law in Birmingham.
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