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At the heart of general practice since 1960

When a serial complainer targets you

Angela is an unmarried headteacher in her early 50s, lives with her aunt, and looks after her devotedly. She attends frequently, and always wants a multitude of investigations and referrals, many of them inappropriate. She has three separate complaints against local hospitals in process. Yesterday she attended surgery to see you, and you were running very late due to an emergency visit. She waited 20 minutes past her appointment time, then shouted at the receptionist and stormed out. Today you arrive to find a hand-delivered letter of complaint from Angela on your desk. In it, she makes a variety of accusations of bad timekeeping, rudeness, and clinical incompetence. She says she has sent copies to the health authority and the GMC.

Three GPs discuss a difficult practice dilemma

Dr Neil Brownlee

'I have no doubts on this one ­ she is off

the list'

Well I don't need to ask the audience or phone a friend for this one. She's off the list.

My first reaction would be a thorough look at the notes to check I had not been clinically incompetent. I would check that her care had been professional and any health beliefs explored.The next step would be to check the receptionist's side of the story. I would then arrange for our complaints manager to write to Angela, arrange a meeting and discuss my reasons for running late.

A letter removing her from the practice list would then follow. I am sure the defence organisations would advise hanging fire but our relationship has clearly broken down.

In addition, she has gone to the GMC without even asking for an explanation. That is below the belt and makes a farce of our informal complaints procedure.

General practice gives good quality of care to the vast majority of patients. It simply does not have the time to pander to serial complainers.

We would have to discuss Angela's aunt in a practice meeting. She may become the focus for future complaints. However, I imagine that we would respect her autonomy and keep her on the list.

There are lessons to be learned from this case. Perhaps we should have discussed her much earlier at a practice meeting. Her several complaints against hospitals combined with a multitude of investigations clearly suggests an unhappy individual. We may even have been able to address her various issues over several consultations.

However, the time for that has passed. Angela may have hidden agendas.

She may be anxious, she may be depressed. She can tell her new GP all about it.

Dr Abayomi McEwen

'I would have no qualms in suggesting that she move on'

The gut desire would be to remove Angela from the list, but that is more trouble than it is worth! Another option would be the obsequious approach, wait until she calmed down, and then find an excuse to remove her from the list at a later date.

The road I prefer is harder but may have a better outcome. I would invoke the practice complaints procedure led by the practice manager. The initial letter of response would acknowledge that she was upset but that the practice found her position untenable. It would include an invitation to meet with me and the practice manager. I would take the precaution of letting my defence union check the correspondence and incorporate their comments in my response.

I am sure she is the type who would like a meeting. The meeting would be cordial but I would be firm. I would apologise that she had been kept waiting but point out that we could not guarantee it would not happen again due to the unpredictable nature of human need. I would ask for an apology for her unsubstantiated claims against my clinical integrity. My final move would be to suggest that my preferred option would be for

us to negotiate a solution that would work for both sides.

It may well be that all her behaviour is 'bravado' and there are underlying psychological issues. Despite my misgivings, I really do believe it is possible there could be a positive outcome.

It may be the first time anyone has acknowledged her distress and given her time and to be heard without responding to her apparently unreasonable behaviour with retaliation. But I would have no qualms in suggesting she may wish to move to another practice if we cannot come to a mutually acceptable compromise.

Dr Aran Gillespie

'After a bit of a rant, I would aim to protect myself and

my job'

If I am totally honest, the first thing I would do would be to have a bit of a rant. This woman has made a conscious decision to attack me in response to my attempts to help another human being more deserving than her. This woman knows she has the right to attack me, upset me and accuse me with all the venom she can muster. I can be her whipping boy, and she can vent any frustration safe in the knowledge that I will respond meekly. My ranting is part of my coping response, as I'm sure bottling things up can't be good for you.

Having vented my frustration at the injustice of our unequal relationship, my aim would be to protect myself from this attempt to put me out of a job. As memory fades with time, I would ask the receptionist involved to write an account of what happened while it was still fresh in her mind. I would do the same.

The basis of this complaint has three main parts. The timekeeping I would be quick to apologise for, but I would qualify any apology with the fact that medical emergencies happen, and failing to deal with them would be unprofessional. The rudeness would need some investigation. I never set eyes on her, so I would be surprised if I was rude to her.

Her claims of clinical incompetence are good ­ I didn't see her. I'd check recent notes, perhaps getting one of my lovely partners to have a look and see if they agreed with my previous management.

I would pass the letter of complaint to our practice manager to deal with. This woman may claim to have told the world about me, but I have only her word on this. I would resist my natural desire to write back and tell her what a cow she had been. Our manager knows the proper complaints structure, so I'd let her guide me through it step-by-step, starting with local resolution.

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