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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 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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