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How do I write a response to a patient complaint?

Terri Bonnici and Sue Taylor advise

Receiving an angry complaint from a patient or their family which questions your care or actions can be very distressing, particularly when you feel you had done everything possible for the patient. You must acknowledge a formal written response within three days of receiving it, but it pays to write a careful response.

A considered response, perhaps with input from an objective colleague, is more likely to lead to successful resolution for you and your patient. There are three aspects to a good complaint response – Appearance, Content and Tone (ACT).

Appearance 

A well laid out letter with clear, consistent formatting and grammatical accuracy will give the complainant a good first impression before they have even read the content. Make sure you have clearly defined paragraphs and no spelling errors. A professional response should have a professional appearance.

Content:

The elements of a good complaint response letter are:

An opening paragraph which places the complaint in context; expresses sentiments of regret and acknowledges the patient’s feelings of distress as a result of what happened, regardless of whether the complaint is justified or not. If the patient has died then condolences should be offered.This is important as the first paragraph sets the tone for the rest of the letter.

A summary of the main issues the patient or their family have raised in their letter.

What action you have taken to investigate the complaint (e.g. spoken to the staff concerned, reviewed records/policies.)

A clear explanation in response to each of the issues raised - what happened and why. When referring to any consultations it is advisable to include:

  • The date, the history and symptoms presenting;
  • Any examination carried out and the findings;
  • Any working diagnosis, your advice, treatment and suggested or arranged follow up;
  • Clinical terms and abbreviations should be explained.

Do not include notes of a consultation copied directly from the patient’s records rather than written in a narrative form. This could cause confusion, particularly if contains acronyms, and lead to further questions.

Consider the matter with hindsight and draw conclusions, which, if possible, should be evidence-based with reference to clinical guidelines, where appropriate.

Identify any failings, apologise for these and provide details of any changes that have been made to reduce the risk of the issue happening again.

An invitation to meet or contact you again if they have any further questions.

Details of redress through the next stage of the complaints procedure to the Ombudsman and their right to use the NHS complaints advocacy service.Details of the NHS Complaints Advocacy Service must be offered to the complainant so they can seek the independent support and advice they may need to take their complaint forward. This is also of benefit to practices when dealing with more complex or challenging cases

A reiteration of your apology for what occurred. There is no need to be reluctant to apologise - an apology for the distress caused or for a misunderstanding is not necessarily an admission of fault.

Do not suggest that patients consider moving to another practice - this could be seen as 'constructive removal' (when a patient feels pressurised to move practices unnecessarily and inappropriately without following the correct removal procedure).

Tone

A full response covering all the main elements can fall at the final hurdle if the tone is defensive and confrontational.

It is our experience that an objective and conciliatory response can defuse a situation and prevent protracted correspondence and escalation to the Ombudsman or even a claim. It may also be worth bearing in mind that the Ombudsman would class a defensively worded complaint as poor complaints handling and thus maladministration, which can attract criticism.

What wording should you use?

You may want to say: 'I refute the allegation that I did not take you seriously.'

It would be better to say: 'I am so sorry if I caused you to feel that I had not taken you seriously, and the distress you have experienced as a result. I can assure you that it was not my intention to cause you additional anxiety. Your feedback has given me the opportunity to reflect on the way I handled the consultation. However, I hope this letter has reassured you that I did act appropriately given the symptoms presenting at the time.'

You may want to say: 'I have to say that I feel that most of the problems that have arisen are as a result of your own demanding and intimidating behaviour towards myself and my staff.'

It would be better to say: 'At times I have found your approach to myself and the staff quite difficult to manage and, whilst I can understand that when patients are unwell and feeling distressed it can reflect in their manner. I do hope that this is something that you too could reflect on.'

Terri Bonnici and Sue Taylor are medical complaints advisers at the Medical Protection Society

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Readers' comments (6)

  • It is very important to also make clear that the complaint (in primary care as well as elsewhere in the NHS) must be answered by a person designated as the Responsible Person (ie someone very senior who oversees the complaints process). There may also be a Complaints Manager who can be designated to answer the complaint as well as managing the investigation and response (Sections 4 and 14 of the 2009 Regulations). An individual GP in a practice writing and signing/sending a response to a complaint other than through these two specified persons is not within the Regulations. The intention of the Regulation is to ensure that no complaint remains hidden from the practice Partners/managers and any disciplinary/regulatory issues are concealed as well as enable the practice to discuss and identify trends and take remedial action.

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  • I agree very much with this advice from an NHS wide position. If patients start from the point that they feel they have been taken seriously and had a sincere apology even with no admission of fault 'I'm so sorry that you felt we didn't give you the best care we could' then often a potentially confrontational exchange has been avoided in my experience.

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  • Make amends - apologize for being alive and daring to breathe, do whatever it takes but DO NOT involve your indemnity provider especially if it is MPS.
    The complaint will wither away with your apologies and going down on knees without a reason to do so but your premium will rise and head northward and there's no return to normality.
    You may end up seeking 'advice how to respond to a complaint' and then be unable to make ends meet due to exorbitant premiums levied due to 'valuable advice' which is basically - just say sorry in every possible way and get on with your life.

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  • Is it just me, or are there grammatical errors in the recommended versions of how to say what you might want to say? ("'I am so sorry if I caused you to feel that I had not taken you seriously, and [for] the distress you have experienced as a result."; "At times I have found your approach to myself and the staff quite difficult to manage and, whilst I can understand that when patients are unwell and feeling distressed it can reflect in their manner [something missing here?...".

    Of course, many doctors will choose to let off steam on the medical forum of their choice, and then write a sensible response, despite the encouragement they may receive on those forums to be forthright.

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  • Always write the response to a complaint with the assumption that your response will be read by a large number of the complainant's family and friends (and maybe others). They will all have their own interpretation and advice on your content and tone and what the complainant should do next.

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  • I agree with most of what is said, but I would add that it may be better to use the wording that the patient has used in the letter of complaint rather than assume you know what they are saying and interpret with your own paraphrasing.

    Good grammar makes for easier reading and I agree with Peter English here - poor grammar, including where you place yourself in a sentence, can make for very 'clunky reading'

    Ensure the complaints process is fit for purpose. Do not assume it will be! If the most senior person is responding, the drafting of the response should be of an equivalent level

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