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Gold, incentives and meh

I’ve learned the hard way to live without patient ‘satisfaction’

Dr Punam Krishan

punam krishan 3 x 2

Having finally made it through a morning-surgery-from-hell, I was just putting the kettle on when the practice manager walked in to hand me an envelope. Hoping it was a rare effort to pay me on time, I opened it to find this correspondence was instead a patient complaint against me. Perfect timing dear manager, thank you.Today has been rubbish.

I am not going to blow my own trumpet, nor do I want to jinx things, but – I never get patient complaints. I am one of those freaks who loves the job, and as part of that is determined to deliver the best care possible and achieve optimal patient satisfaction, from my end at least.

As I started to read through the two-page essay of horror, ‘I am writing to complain about the manner of the locum doctor…’, I felt my heart race. The manager helpfully lingered to watch me read through the long list of allegations.

All my ninja powers together were unable to tackle more than two and a half of her problems

The complaint was partly about how this patient had to wait a whole eight minutes to be seen. Thank lord she did not attend this morning, I thought, or I might have been facing a GMC hearing.

My memory of the encounter returning, I recalled she had booked the appointment as an emergency and been fitted into my already over-booked surgery, the reason being described on screen as ‘unavoidable’.

As per normal etiquette, I apologised for the slight delay. It was too hot in my room apparently, so I watched her take her time to un-layer and settle in.

‘I have a list,’ she said. With crippling heart sink and internal rage, I fought off the urge to snap at her. It had been a brutal afternoon, consulting for three hours non-stop and I still had so much left to do.

I advised her that she was booked into an emergency slot and therefore I could only deal with her most important problem that day and could she kindly re-book for her other more routine issues. She wasn’t for listening.

Here, dear reader, I present you her list:

1. I need my medications

2. I have this odd lump on my arm

3. I want you to review my chronic back pain because I believe I’ve been misdiagnosed

4. I have recurrent UTIs and want to see a urologist

5. I need a jury exemption

All my ninja powers together were unable to tackle more than two and a half of her problems, leaving her with no option but to re-book. I had ten minutes, she took fifteen. I still had four other ‘emergencies’ waiting, special requests, paperwork and telephone calls to action and it was 5.20pm. I had to pick up my son from aftercare at 6pm.

So, her subsequent letter informed me that she works full time and can never get an appointment, and therefore it was her right on this day to have as much time as she needed with her doctor to address her ‘serious health concerns’. She condemned my failure to provide this as ‘despicable’ and questioned whether I should be a doctor at all.

Deflated, I wanted to call her. To say sorry that she felt my manner was not to her standard, but perhaps I came across rushed and harassed because I was rushed and harassed… and that I did not appreciate her manipulating the emergency appointment system to accommodate her work schedule. I wanted to tell her that I have the same issues trying to get an appointment with my own GP. I wanted to explain to her that as a locum GP, I had come in to the practice that day not knowing a single patient, the system, or the practice team and that this was pretty isolating. I wanted to tell her that much like herself, I also work full time and on the day in question, I was 35 minutes late picking up my son from after school care and all I wanted to do was cry.

I can’t call her, so instead I rant to you, my husband when I get home and probably a friend to be reassured that I am not a crap doctor.

As I sit here and think about my response to this patient, I do feel sad that someone felt this way because of me. I wonder if, at the end of what was a brutally busy day, my manner could have been a bit brusque?

But I cannot see what I could have done differently clinically without compromising her care, or the care of the other ‘emergencies’ waiting to be seen. I could not give her the unconditional time and attention that she wanted, without setting this standard for others.

I did try to once upon a time – and I burnt out. I’m not going there again.

Dr Punam Krishan is a GP in Glasgow

 

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Readers' comments (35)

  • I would have said "Your UTIs are due to kidney cancer which has spread to your bones and also to the skin, hence the lump and back pain. The case you have been asked to be a jury member starts in 4 months.I wouldnt worry about that.Have you made a will?".

    I'm beginning to worry about myself, and these vivid dreams of complete frankness with my patients that I have begun to have in the past few months........

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  • Don’t take these personally. Solicitors and builders don’t take complaints personally why should doctors?
    The real reason for her consultation was the last one on the list.
    Well done for standing your ground and don’t ever work for that practice again. The manager should be ashamed for his treatment of you.

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  • Wouldn’t worry about that complaint - I enjoy them!! Gives me a chance to rant about the NHS and a complaitnfor our appraisal!

    I do no apologise for these sort of complaints either.

    Emergency appointment means one complaint only - full stop. If they are not happy tough!

    I have occasionally walked patients to the front desk to give hem a complaint form myself

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  • Cobblers

    Learn to say NO.

    Seriously.

    It was a last minute emergency fit in. One problem and it had better be an emergency. So you then dealt with 2.5 problems with no emergency in sight.

    You undermine yourself. You anguish. You feel a bad person.

    Don't waste a moment more. Leave it to the PM who is paid to deal with this crap.

    Get on with the important things. Family. Enjoyment at work (still possible). Time for self. Did I mention family?

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  • hope the practice you locumed for were supportive .would like to think my practice wd have made a few things very clear to that patient. wish I could say there aren't plently more like her out there...it helps me to think of some of them as the'Friday Night Specials',a lbel does sometimes help the perspective

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  • This is not what the NHS is for but what it has become. At least in primary care. People like this have no concept of the value of healthcare, the entitled demanders. Only when it is lost will they start to get it.

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  • AlanAlmond

    I feel for you and know exactly what you mean as I have experienced exactly the same scenario and felt exactly the same. To be honest it was these kind of encounters that played a large part in my decision to move away from practicing as a GP. I’m not quite there yet and still need to pay my mortgage but I’m getting there. Perhaps there is something wrong with me, perhaps I need to grow a thicker skin, but perhaps, just perhaps, there are other things I could be spending my time and creativity doing - like being a Dr in a country where my skills would be put to better use. Or doing something entirely different. There is something about the self entitled, unthinking, demanding attitude of an increasingly vocal minority of people, that seems to grow month after month, that does make you wonder - you only have one life, you need to spend your energy wisely. Is working as a GP in the U.K. really the best thing to be doing? It’s an individual decision - for me it became clear a while ago. Something else is where it’s at.

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  • Is it not hypocritical that we are thought to us open ended consultations but instead thee systems we work in militate against that and snuff the very thing we trained to do as good doctors.

    The question is who do you think is the hypocrite,i will go as far as saying,the pied piper of hamelin?

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  • IDGAF-you are brilliant. I could use that and send them on a 2 week wait straight out of my room. Job done.

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  • This was not about you it was all about her!!
    Next question is who responded to the complaint and how? Grovelling or fair but firm?

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  • IDGAF that really made me laugh out loud ! a concise response !

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  • Hi Doc
    Relax and go on doing your job without worrying about complaints.These are commen scenarios we see day in and day out.You acted as a responsible clinician and said what you said.I tend to see such patients at the end of surgery so other pts are not delayed.
    I had a recent experience when one of the patient - a solicitor- walked expecting to be seen for CD drugs for her backache as she was going away. We had no appts and a letter came from NHSE to me re her complaint.
    Having gone through her records I found she had threatened every dr that she would complaint to GMC if she was not given her drugs when she demanded them.I responded to NHSE and mentioned her
    threats to all drs in the past and to us. NHSE supported us. Now I am thinking of writing a complaint against her about her behaviour towards us.
    Shall I write to the law society?Hope NHSE supports us.
    In summary relax, enjoy your locum work and without worrying about who comes through the door next....

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  • As a profession we will never get things like this under control until we have the absolute right in law to complain back without Fear of reprisals. Just imagine - at a time when it is getting harder to find a GP - if you were able to say to her that this is an abuse of the system - no one coming in with a list is EVER an emergency - and to be complained about as well is simply not acceptable - and that any repetition will lead to her being thrown off the practice list... This would sort it out once and for all.

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  • For the best part 15 years the annual number of formal complaints logged against GPs in England and Wales has run at more than one complaint per full time equivalent doc. The chances of 'copping one' at least once a year - as a locum - are probably even higher.

    The author of this article has been unusually fortunate up until now - I suspect because she has unusually good interpersonal skills.

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  • Many years ago while training for consultation skills we had a particularly obnoxious aggressive and up his own orifice actor who had made numerous young trainers cry with his manner. As an older graduate I was even then a stroppy git and decided enough was enough with this horrible man. Breaking away from the boring script in the role play I leaned in and pulled a horrified face "hmm you know that mole on your eyebrow... it COULD be cancer" which was true but at the 0.0001 probability level. It stopped him in his tracks and he left the building minutes later. We do have the power to change lives.

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  • Yes the main learning point from this encounter is if an 'emergency' appt the you just deal with the single issue 'emergency'.....she gets to pick from her list which this is....the rest can be deferred to a routine appt.

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  • IDGAF for Health Secretary!!!!

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  • The poor spouses/partners get it every time!!

    Water off a duck’s back ......

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  • My take on replying to such petty complaints is if you spend more than 5 minutes writing a response the patient has won.... My proud record is a 3 line response.

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  • The first step is to realise you are merely a tiny, almost insignificant cog in a massive edifice. Even if you worked 20-hour shifts you'd not make the slightest impact even if by some miracle you were on your "A" game for all 20 hours, 7 days a week.
    I want to see (for example) a lawyer, I pay per hour. They can allot a 6 hour slot since I paid in advance for this. If I need 6 hours and I can afford one I get one and a disclaimer that they did not have enough time.

    I work for my family and I provide a service to fulfil a contract to get paid. Those that don't like it can go elsewhere.

    Viewing myself as an average white collar worker might make it all mundane, but also means my limitations and those of the system I work for.

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  • "I do feel sad that someone felt this way because of me."

    I totally identify with this thought process which then leads to negative emotions and distress.

    However it is totally wrong - the patient feels the way she does because of her own ego / perception of self / upbringing/ conditioning etc. The anger coming from this individual was there before she had the consultation with you. Maybe in some small way the fact you were able to remain assertive and focused during the consultation will help her in the long run.

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  • Vinci Ho

    Now we understand the true meaning of ‘emotional resilience training like soldiers in Afghanistan ‘ as advocated by Terence Stephenson (the current GMC chair on his way out end of this year) in 2015: grow ten inches thick skin on your face and learn how to sing Dua Lipa’s current hit , IDGAF.
    Truth is, Punam , complaints and even being sued , do not raise a ripple in my heart anymore because I know the whole system is failing NOT because of me and you. Get used to singing those words ‘ I am sorry ‘ ; ‘I apologise ‘ as the ’tokens’ you had to use in a video game . Of course , you have a choice of whether you want to ‘mean’ it or not!

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  • Loving IDGAF response. I started off as a nice doctor asking lots of open ended questions. I attracted all the heartsinks and had several complaints.
    My consultation model altered. My demenaour now is one of great stress and pre-occupation. I generally offer no suggestion as to the diagnosis or management plan. I rant about the state of the NHS and my own health. If the usual "exit" strategies fail then I leave the consultation myself and put the kettle on and head off to reception to complain about something. If patient still there I sit down and hold my head in my hands until they eventually wander off.

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  • CENSORSHIP?

    Do not respond to the patient directly
    Write the reply to the practice manager detailing the abuse of
    The emergency slot
    The repeat prescribing process
    The charge for private letters
    The practice policy on multiple complex problems
    And wether the practice is happy to pay for a session that runs late..
    And state that catch up slots are required..to allow timely completion
    Esp as you need to collect children ...or commute to the next job...

    Often those booking emergency slots will not disclose the issue
    Hence the lists above

    Sign post to reception
    Request double appointment...

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  • It is a sad reality of our everyday life. No one is interested to solve it for the GPs and you are left alone to battles it out yourself and risk of getting complaints.
    It is really shameful that NHSE and the GMC are wilfully blinded to these working conditions faced by doctors day in day out.
    GMC should be ashamed of not protecting doctors who are forced to work in such demanding environment and with great risk of making mistakes.
    GMC is very open to hearing about complaints about doctors making mistakes but blind to the causes and the risky working practices that are created due to pressure of work.
    UK General Practice in its current form is done for good and we are already seeing the results of this every day as experienced doctors leave the GP land.

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  • Unfortunately, some patients are just too selfish and they don't care about their doctor, as long as they get what they want.

    Especially for this group of patients I am very strict I will do my agenda set and make it clear we have 10 minutes and that is all and we won't cover everything. I always say to them if you wanted more things covered then either come back if you want and consider booking a double appointment. I have a few like this patient just don't like it, well tough, I am there to do a job and offer an equal service to all not a special extra 20 minutes for her alone.

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  • You are not the problem
    Problem is system
    Vast majorly of patients attend surgery with trivial complaints often self limiting and not enough time is available dealing with real medical problems. Also no education on mass media about common self limiting illnesses

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  • The part I practised in training-I can deal with 1 problem in 10 minutes and if more issues will not be able to resolve the other satisfactorily. Please give me list of issues and lets see what I can do for you now.
    Patients forget that doctors are humans and need to pick up children, be responsibilities etc. Nobody will give discount in after school childcare if they know you are GP but will says 'Oh a GP, surely can pay'

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  • Agree - only true emergency depression is suicidal. Everyone else has choice of 1. counselling 2.medication 3. medication plus counselling 4. option of doing nothing. End of. Don't need to hear the rest.
    Also - do some observation surgeries observing fast consulters - in a different practice if it makes it easier - you will gain easy CPD, and lots of good exit strategies - I gained from this when doing GP I&R scheme.

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  • The non clinical mad ones can safely be left to the PM to answer! Not a medical job, no clinician required. These are often only offered to you for appraisal purposes.

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  • I hate to say it, we all go there week in week out, and sadly the longer you do this job the more you wish you could go back and re-do your UCAS forms. There are better ways to race towards your grave! Good luck for your career,

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  • You should try being a 50 something white male GP. I think we are open season for a certain type of complainant, often similar to the demographic I think described here.
    Often it is power thing, a type of abuse where the abuser/complainant gets an emotional gain by their manipulation by use of the complaints system.
    Like may abusers they are serial offenders with years of practice since childhood.

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  • From the complaints section of my appraisal

    "I was really shaken and shocked by this complaint. From a patient I have known for the past 20 years I received a vicious and slanderous letter of complaint accusing me of taking back handers from the makers of the Revitive machine.

    My jaw actually slackened as I read the complaint. I usually ask my PM to respond to complaints but I was so wounded by this one that I decided to write my own response. I know my response is strong--but this sort of slanderous allegation must be defended robustly. The complainant is a great user of social media and I am keen that she understands my position with great clarity. I would consider legal action if she tries to defame me on social media.

    Doctors are incredibly vulnerable to complaints and patients have many avenues to pursue their displeasure. In my career to date I have had to deal with complaints from the following



    1 Internal complaints process

    2 PALS

    3 Ombudsman

    4 CQC

    5 GMC

    6 NHS England

    7 PCT/CCG

    8 Solicitors

    9 Press

    10 Radio

    11 Out of hours



    Medicine attracts people who are sensitive, caring and self critical. Then exposes to them this. There is very little support and I have developed a thick skin over the years. Nevertheless this complaint hurt from a patient that I have cared for to the best of my ability for over 2 decades.

    As Lear astutely points out

    "How sharper than a serpent's tooth it is
    To have a thankless child! Away, away!"

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  • A graphic reminder of why I took early retirement. Good luck finding a route to a sustainable work/ life pattern. In a way this type of complaint cheered me up at times, it is so patently ridiculous! I do miss some of the more lovely patients though.

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  • I think most of our professional sorrow comes from taking our jobs too seriously. It may help if we think of it largely as an interesting mean to earn a resonable/good living. It means we lose out on some joys of feeling wonderful about ourselves, but we can then individually fine tune this balance.......

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