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At the heart of general practice since 1960

Preventing and detecting type 2 diabetes complications

How to handle your first complaint, and learn from it ­

by Dr Melanie Wynne-Jones

If your practice strives to be caring, efficient and patient-centred, it may come as a shock to discover that some patients don't see it that way.

If a patient wishes to make a formal complaint about someone in the practice, you must inform them that the practice operates a complaints procedure; ask a member of staff if you don't know how it works.

Patients wishing to complain about hospital doctors must use the hospital's own complaints procedure. PALS (Patient Advice and Liaison Service) helps patients with complaints about the NHS, and can be accessed via the PCT.

Explicit complaints about doctors tend to be made to partners or the practice manager rather than to GPRs. Most GPs would immediately ask about the problem in the hope of resolving it quickly. It may be appropriate for you to do this; it shows concern and may be helpful. But it is not your responsibility to manage the complaint, and you should seek advice promptly.

Patients often make asides about doctors, for example 'Dr X wasn't interested', 'Dr Y fobbed me off', or even, now that doctors are generally less respected, and casual swearing is commonplace: 'That Dr Z is a....'

The difficulty with this type of remark is whether to respond or ignore it.

If you ignore it because you think the patient is letting off steam, has unrealistic expectations or is a habitual grumbler, you risk being accused of not taking the complaint seriously or of shielding a colleague. You are also denying the doctor/practice an opportunity to respond, and in rare circumstances the doctor's behaviour may be a clue to poor health or overall performance.

Asking for more details may encourage the patient to complain further, but the GMC's Good Medical Practice (see below) requires us to put the patient's interests first. This could include establishing whether the remark constitutes an actual complaint and/or whether the patient has been harmed or put at risk.

Reflecting the comment back ('Dr Y fobbed you off?') may reveal additional information that the patient expected Dr Y to explore, allowing the consultation to progress satisfactorily. But this information may indicate that Drs X, Y or Z acted skilfully and reasonably. The patient may accept this; if not, it is up to them whether to take matters further.

As a practice employee, ignoring a complaint will also conflict with your contractual duty. If the complaint is about a practice employee, this must be handled by a partner or the practice manager, as disciplinary or grievance procedures may be invoked ­ with potentially serious implications.

Telling a colleague that someone has complained about them can be difficult and embarrassing. Negative feedback is usually best done on a one-to-one basis, seeking to clarify rather than accuse; you may not be aware of highly relevant information.

As a GPR it is wisest to run things past your trainer first, or even to have your trainer present; this may turn out to be bigger than you think, or uncover wider practice issues.

GMC: good medical practice guidance about complaints

29 Patients who complain about the care or treatment they have received have a right to expect a prompt, open, constructive and honest response. This will include an explanation of what has happened, and, where appropriate, an apology. You must not allow a patient's complaint to prejudice the care or treatment you provide or arrange for that patient.

30 You must co-operate fully with any formal inquiry into the treatment of a patient and with any complaints procedure which applies to your work. You must give, to those who are entitled to ask for it, any relevant information in connection with an investigation into your own, or another health care professional's, conduct, performance or health.

GMC Ethical Guidance www.gmc-uk.org/standards/default.htm

GMC: duties of a doctor

·You must act quickly to protect patients from risk if you have good reason to believe you

or a colleague may not be fit to practise,

and

·You must work with colleagues in the ways that best serve patients' interests

·You must never discriminate unfairly against patients or colleagues, and you must always be prepared to justify your actions to them

Melanie Wynne-Jones is a GP in Marple, Cheshire

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