Despite our best efforts there are times in a doctor’s career when things do not go according to plan, or a patient will be in some way dissatisfied with the treatment they receive. There are many things we can do to reduce this risk; however, complaints and complications can arise at any stage of a practising doctor’s career. Handling these events appropriately can make the difference between a swiftly resolved concern with a good ongoing doctor-patient relationship, and an escalation of concerns that may reach the sight of your regulator or result in a disciplinary investigation.
An important priority for any doctor involved in an adverse incident is their health. Complaints, complications and critical incidents can have a significant impact on your wellbeing. This potential is often overlooked by the individual and their colleagues. There are resources available that offer support for doctors facing difficulty, including NHS Practitioner Health. If you or a colleague have been involved in any case with a negative outcome, please do consider the health implications and the support available.
The risk of receiving a complaint from a patient exists in the private sector as much as in your NHS practice. Trusts will commonly have a complaints team to manage such matters; however, in the private sector this is not universal. Although private hospitals may have a Complaints Lead, a private practitioner is more likely to receive a complaint from a patient directly rather than via the hospital, and may not have access to the same level of support when responding to that as would be available from an NHS Trust.
A complaint is an expression of dissatisfaction that may not always come in the conventional form of a letter. It is a common error to assume that a complaint made verbally to another member of staff or a comment on social media, for example, deserves less attention. Any negative description of the treatment that the patient has received is a complaint and should be managed as such. Medical Protection assists many of our members with guidance on responding to a complaint. Our support and advice reduce the stress of receiving a complaint and can improve the likelihood of a swift and satisfactory resolution.
There are principles of good complaint handling which, when applied, are more likely to result in a resolution of the complaint and reduce the risk of escalation or criticism of you for poor complaints handling. In summary these are as follows:
It can be difficult for any doctor not to take a complaint personally and this can allow the complaint to adversely affect the doctor-patient relationship. Paragraph 61 of Good Medical Practice 2013 (1) states: “You must respond promptly, fully and honestly to complaints and apologise when appropriate. You must not allow a patient’s complaint to adversely affect the care or treatment you provide or arrange.”
Whilst it may be appropriate to offer a second opinion or an alternative clinician in some cases, caution should be exercised before ending a professional relationship with a patient while a complaint is unresolved, unless this is requested by the patient.
It is not uncommon for a third party to complain on a patient’s behalf, for example a family member. Before responding, it is important to establish that you have appropriate consent in place to avoid the risk of breaching your duty of confidentiality.
Complainants can use legal terminology such as “negligence” within their correspondence. Fear of litigation may naturally add to the anxiety caused by receiving a complaint. The use of the word negligence does not necessarily mean that a claim is inevitable; however, it is important to distinguish a clinical negligence claim from a complaint. There are some indications that a complainant may be considering making a claim, such as a request for their medical records. This request can come from the patient, a representative or a solicitor. If you are concerned that any complaint or incident may result in a claim, then it would be wise to inform your MDO or insurer at an early stage. This is important as there are strict time limits in which a claim must be acknowledged.
All complaints should be discussed in your appraisal irrespective of whether they arise from your NHS or private practice. Evidence of reflection on a complaint can certainly improve your position in the unfortunate event that a complaint is escalated by the private provider, your NHS employer or the GMC.
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Complications can arise from appropriately conducted surgery or medical treatment. When complications occur it is a stressful experience for the patient but also for the doctor involved. The consenting process should include a discussion of all known complications or side effects of material importance to the patient. However, if the complication was discussed preoperatively this does not alter the fact that there has been an unwanted outcome. The GMC makes clear a doctor’s obligation in Good Medical Practice (1) paragraph 55:
“You must be open and honest with patients if things go wrong. If a patient under your care has suffered harm or distress, you should:
As soon as the clinician is aware that a complication has occurred it should be discussed openly and honestly with the patient and an apology offered for the fact that it has happened. An apology is not an admission of liability but a human response that demonstrates empathy toward the patient. This stance can go a long way towards avoiding a complaint or claim. The GMC has separate guidance on a professional duty of candour, which gives practical advice and explains in more detail a doctor’s obligation to a patient when things go wrong.
There may be learning from any complication that has the potential to change your practice and that of your colleagues. System errors and human factors can contribute to any complication as much as the actual conduct of surgery or treatment. It is wise to consider whether a complication that has occurred meets the threshold for reporting on the private provider’s incident reporting system. Doing so offers the opportunity for learning. It also demonstrates a doctor’s openness and willingness to learn from such incidents. Failure to do so may risk criticism for not complying with professional or contractual obligations. If you are not sure whether a complication requires reporting, it would be wise to seek advice from a senior colleague or the patient safety team. Complications in the private sector and your reflections on them should be discussed in your appraisal, regardless of whether your Responsible Officer is in the NHS or a private organisation.
Complaints and complications can arise for any doctor at any stage of their career. Appropriate action and a considered response can limit the potential for an adverse impact on a doctor’s professional welfare. It is wise to seek advice from your MDO early and be mindful of your own health during the process.
Want to know more? Face down the fear of complaints by listening to our podcast You are not a frog, hosted by Dr Rachel Morris, a GP, Speaker, Executive Coach, and specialist in resilience in the workplace
Good medical practice - ethical guidance - GMC (gmc-uk.org)
Openness and honesty when things go wrong: The professional duty of candour - ethical guidance - GMC (gmc-uk.org)
The Practitioner Health Programme can be found at practitionerhealth.nhs.uk/.
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