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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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  • UtterFool

    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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