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GPs buried under trusts' workload dump

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)

  • 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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