A lovely reader of this blog has asked me to write a post on complaints and I am happy to oblige. Complaints come, no matter how marvellous you are, no matter how pleasant and decent and good you think you are, you will inevitably have to deal with a complaint.
Complaints are like any feedback, they represent a useful moment to reflect on your practice and how you appear to others.
This is the policy and advice from the NHS in England on how to make a complaint..http://www.nhs.uk/NHSEngland/complaints-and-feedback/Pages/nhs-complaints.aspx
The people who complain are not the ones that you expect, by which I mean the anastomotic leak that stays in hospital for 3 months and requires two further laparotomies and a month of TPN is usually grateful and appreciative of your expert care that rescued them from the brink of death. You should instead beware the person who stays 48 hours and has no acute surgical problem, these are the complainers.
The purpose of dealing with a complaint, for me, is to make it go away and not lead to further grievance. It is not the moment to try and justify what you said or did or score points.
Let’s take the common complaint of “not caring enough and not spending enough time with me”, this was a complaint about me recently in a patient with, by the time she and I met, a CT proven diagnosis of diverticulitis. I erroneously thought there was no need to take a massive history as the troops had already told me all about her, I had instructed them to do a CT and most unusually we had got one within a few hours and had a diagnosis. Job done, great care! Or so I thought…
She said I was in a rush and didn’t seem to care about her. Now, in all honesty I probably don’t care enough about this 48 hour stayer that wasn’t super sick and I did spend the right amount of time on her in the context of the emergency ward round on a busy Monday where she had a diagnosis and a plan and most of them didn’t. But I went about it all wrong, I quickly prodded her tummy, looked at her CT, growled at the junior who hadn’t commenced antibiotics (happy to discuss benefits of this or not, but in Bighospitalburgh we do) said a few words to her about the natural history of her condition and moved on.
One hour later I am called back to see her and her daughter to apologise, which cost me 20 minutes.
The response to a complaint cannot allude to her need being less than that of any of the other patients, nobody likes to hear how they were the least important person on your radar.
This is instead your opportunity to deeply regret how your behaviour made them feel, that you are saddened and ashamed that any person under your care would feel that you didn’t have their wellbeing at the centre of what you are doing. You have reflected on their comments, you have taken them on board (a phrase I never use in real life), and you will do better.
None of this is being said with my usual jaded sarcasm. I made an elderly, frightened, unwell lady feel bad and genuinely I am ashamed of that.
One of my much respected senior colleagues, as senior as they come, sits down next to old ladies like this and takes their hand and introduces himself. He appears to the patient to have all the time in the world, he tells them that “his team” has kept him informed of everything that has happened during her admission and that he is pleased with their swift and accurate diagnosis and management. Then he asks them a question like “And how are you? Anything you want to ask or to tell me?”
(I know! He’s great and I am still such a total amateur at this, after 20 years of medicine. I hope that having some insight into my failings will lead to being as good as my colleague.)
I still feel bad about this, if someone made my wee Granny feel frightened and neglected I would be most displeased with them.
The other complaints I have had experience of have been of two varieties; communication related and people upset that I told them to lose weight, which is also communication related.
It is apparently “easy for me to say” as a normal BMI individual that people must lose weight. It certainly is not easy to say, and I have a new policy with weight; I only mention it if they do or if I truly feel I cannot operate on them due to their BMI.
The best advice I can give you when dealing with a complaint is to say “What happened? What should have happened? What is the difference between those two things?”
This should form the basis of your response, along with the words “I am sorry that you feel”. The medical notes are crucial in your defence of a complaint. “She didn’t care” can be met with a robust response that you saw her twice a day, examined her carefully, sent her home with a sack of painkillers, an outpatient appointment and that she was discharged well aware of the plan. If the notes just say “Home” you have a problem.
Serious complaints of medical negligence are a different sort of thing to what I allude to here. Legal advice and defence union input should be sought in the event of such an allegation.