AUTHOR: Dr Lesley Morrison
As well as all the positive “c” words of being a doctor, there is, unfortunately, a less pleasant one: complaint. It’s a rare doctor that gets through their professional career without a complaint being lodged against them. Occasionally doctors sense, after fractious interchanges, that it’s coming.
Sometimes it arrives from left field. Someone that you’ve slogged away with, and done your absolute best for, rewards you with a complaint. Possibly this happens because they feel so powerless in other aspects of their life that they need to exert some power over someone close to them.
Or it may be because they’ve responded to the advertising of an unscrupulous lawyer. Or again it could possibly be because you, by reminding them of someone they would rather not be reminded of, have pushed buttons for them.
Sometimes they are angry at being given a difficult diagnosis and you’re the one that gave it to them. Sometimes, their whole life is so stressful and difficult, as has been the case for so many people during the pandemic, that anyone perceived to be in a position of power is a target for their upset and antagonism. Lastly, it could be that they have a point, and a justifiable complaint. All of the above are learning opportunities, potential tools. And all of them initially feel rubbish.
A GP friend in the north of England, Martin, told me this story. His colleagues used to have a GP cooperative for doing out-of-hours, and in the middle of one night he was rung by a man he didn’t know, Jim, who requested he visit for a fairly minor problem. Martin felt that it could easily wait until the morning and would have been much better dealt with by his own GP.
He talked to Jim, tried to reassure him and advised him to ask for an appointment the next day. Jim was clearly disappointed and, two weeks later, the practice manager showed Martin the complaint he had submitted: “The doctor had refused to visit.”
Martin went over his detailed notes and his memory of the phone call, checked that Jim had indeed subsequently seen his own GP and that his judgement that the problem had not needed immediate attention had been correct.
After conversations with the health authority’s complaints officer who was also communicating with Jim, it was agreed that there would be a conciliation process and, two weeks later, Martin met with Jim and ACAS (the Advisory, Conciliation and Arbitration Service) facilitator.
What emerged was fascinating. After Jim laid out what had happened and Martin expressed regret that he had been dissatisfied, but also that he felt he had not done anything wrong, the facilitator encouraged deeper sharing.
It turned out that Jim’s father had been a single-handed GP in the days when GPs did all their own out-of-hours’ work. He had spent all his time caring for his patients during the day, then did home visits at night, and had never had time for his son.
Jim still felt sad, bereft and, although he was reluctant to admit this, angry. His anger had spilled over to another GP, Martin, who had seemed to ignore his needs. By the end of the afternoon, and thanks to expert facilitation, they both arrived at an understanding of the other’s position, and, to Martin’s delight, Jim chose subsequently to consult him as his GP.
The lesson? Communicate, communicate, communicate, and record, record, record! Especially if you sense that the patient is unhappy with what you’re saying or doing, record, with quotes, what’s said and, if you do end up having to defend your actions, try to see it from the patient’s point of view and explore what background issue might be triggering the complaint. Avoid adopting an adversarial approach and resist seeing the patient as “other”.
As is obvious in current politics as well as everyday life, the more someone feels vulnerable or defensive, the more they may be inclined to promote the concept of “us and them”, to create division and resort to “otherness”. Attitudes towards the climate emergency provide a good example.
For some people, fearful of the implications of the climate crisis, it can be convenient and self-protective to put climate activists in the category of “other”, to dismiss them and thus justify their own lack of engagement.
Doctors can also be guilty of this “othering” in the clinical situation by attributing blame to patients for not following instructions or declining treatment when, in the patient’s shoes, they may have done the same. Doctors are, at times, also patients, and we can usefully apply lessons from our own patient experience.
The bottom line is that we’re all human and, by and large, doing our best. Complaints can be used as a learning tool; be honest and open. Everyone makes mistakes; a genuine apology goes a long way and, with a bit of luck, the episode may open up new fertile territory in your relationship.
This article is an extract from The Wellbeing Toolkit for Doctors by Dr Lesley Morrison, published by Watkins and available from Waterstones for £10.99