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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 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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