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At the heart of general practice since 1960

Your first.... complaint from a patient

A quick response, full explanation and prompt apology is often the best course of action, advises Dr Stefan Cembrowicz

A quick response, full explanation and prompt apology is often the best course of action, advises Dr Stefan Cembrowicz

Take all complaints seriously, no matter how trivial they seem. Toyota workers celebrate when a mistake is found as the model can then be improved, though we GPs are not so self-effacing. We can find complaints very stressful, as they cross the line between professional and personal. But prompt and effective complaint management reduces disruption of our personal well-being.

In-house complaints procedures make our lives easier, as formal procedures are in place to explore and resolve dissatisfactions without reaching the stage of involving outside agencies such as the PCT (for breach of terms of service), the GMC (for failure of professional standards), and civil or even criminal law courts (if harm may have befallen your patient).

Many complaints arise because of failures in communication. Our local hospital trust spends several millions a year on complaints solely in this category.

Most of our complaints are resolved early by listening actively and carefully to every detail of the problem, followed by an expression of sympathy, and a clear explanation of what has happened.

If a mistake has been made, and you can be seen to have acted in good faith, patients will be more likely to be satisfied with an explanation (and an apology when appropriate) than with an evasion. Apologies cost nothing.

Prevention

Use your communication skills, soliciting feedback and checking patients' understanding of what has been said. Keep clear records. Medical defence organisations spend much of their time and our money settling cases where records are inadequate.

A patient can complain orally, in writing, or by e-mail. They can also be represented by PALS – the Patient Advice and Liaison service. PALS, an independent third party, can actually be helpful to both sides in sorting out disputes and misunderstandings.

Your in-house complaint procedure will resolve almost all complaints at an early stage. Your practice manager will respond within two days and will offer to meet with the patient by appointment within 10 days to go through what went wrong. A written explanation may be sent later with details of any system changes put in place, and information on what to do next if the patient is not satisfied.

If you receive a lawyer's letter about a clinical matter, acknowledge it immediately and contact your defence organisation which will then handle matters for you. When a more serious complaint arises, do not think of altering your records. It is, however, quite legitimate to make a dated signed contemporaneous record of any further details you can remember about the case at that time.

It may be wise to keep your own copies of correspondence separately filed. I have recently been approached by solicitors about complaints arising from the 1980s. Records retrieval from the groaning NHS records haystack is often not possible.

Stefan Cembrowicz is a GP trainer in Bristol

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