The silent burden: what complaints really cost GPs

The emotional, psychological and professional toll of complaints are just as damaging as the legal implications, argues Rohan Simon, CEO, Medical Defense Society.

This is part of the Pulse Partners series. This article has been paid for by the Medical Defense Society, with editorial input by Pulse. The opinions in this article do not necessarily reflect the views of Pulse.

In the modern landscape of general practice, the spotlight often falls on the legal and financial dimensions of medical complaints. Yet, beneath the surface lies a far less visible but no less damaging reality. It is the emotional, psychological, and professional toll that even a seemingly minor complaint can impact a GP. This silent burden rarely features in the headlines, but it profoundly shapes the careers and wellbeing of those who shoulder it.

A large-scale BMJ Open study of nearly 8,000 UK doctors found that those with recent or current complaints were significantly more likely to suffer moderate to severe mental health issues: 16.9% reported depression, 15% reported anxiety, and they were more than twice as likely to experience suicidal ideation compared with doctors without complaints. The emotional burden was most severe when complaints involved GMC referral. The study also found that over 80% of doctors responded by practising defensively, while many reported bullying, victimisation, or taking prolonged time off work.

We come across many cases like this. For example, Dr L a GP with 14 years of unblemished service, receives a complaint from a patient who feels their concerns about fatigue weren’t taken seriously. The issue is handled at the practice level, deemed unsubstantiated, and closed within two weeks. No formal proceedings follow. Yet the emotional impact is significant.

Dr. L experiences sleepless nights, anxiety during future consultations, and a decline in confidence so severe that she reduces her clinical hours. She could later describe the episode as a ‘psychological fracture’ that is invisible to others but deeply felt.

The cost beyond the claim

There is a tendency to focus on the conclusion of a complaint – whether a claim was upheld or whether regulatory action was taken. But for many GPs, the damage is done long before any outcome is reached. The ambiguity, the fear of reputational harm, the isolation; these are the shadows that linger.

This hidden burden manifests in multiple ways:

Loss of professional confidence, leading to defensive medicine or withdrawal from certain types of consultations.
Emotional exhaustion and burnout, especially when complaints are perceived as unjust or lacking context.
Erosion of doctor-patient trust, fuelling further complaints or dissatisfaction.

A 2018 BMJ Open peer-reviewed qualitative study exploring why UK GPs leave direct patient care identified that concerns about fear and risk, particularly around complaints, litigation, and regulatory complexity, were a central factor in GPs’ decision-making. Interviewed stakeholders highlighted how medico-legal fears and administrative burdens shaped intentions to exit clinical roles, alongside personal and professional identity factors and broader lifestyle considerations.

Patients are more empowered, more informed, and in some cases more litigious. Digital platforms have accelerated this shift. NHS reviews, Google ratings, and even social media posts can act as informal, unregulated complaint mechanisms that carry public consequences.

Yet behind many complaints there is a deeper truth: patients often seek to be heard, not to litigate. Miscommunication, unmet expectations, or fragmented care pathways can quickly escalate into formal grievances.

The need for early advice and a better environment

At the Medical Defence Society, one of the most consistent insights we hear from GPs who’ve experienced complaints is the value of timely, calm and human advice, not only to manage risk, but to support personal wellbeing.

When a doctor feels vulnerable, uncertain, or under scrutiny, the act of speaking to someone objective, informed, and empathetic can make all the difference. Not every concern requires legal navigation; many situations simply need clarity, context, and communication support before they escalate.

Early guidance can:

Reassure clinicians that their decisions were clinically appropriate.
Help reshape conversations with patients to restore trust.
Highlight wider systemic pressures or misalignments that may have contributed.

In essence, it’s not just about resolving a complaint – it’s about supporting the individual behind it. Thereby ensuring GPs aren’t left to navigate emotionally charged situations alone is a responsibility that should be embedded in every structure that surrounds and supports the profession.

We must also move towards a culture where responding to complaints is approached with honesty, proportionality, and care. The GMC’s Good medical practice 2024 recognises the emotional impact complaints can have on clinicians and highlights the importance of timely, fair responses. It also calls for compassionate working environments that support open discussion, learning, and the wellbeing of professionals.

But there’s further to go. Healthcare systems should embed:

Reflective spaces within practice teams to talk about complaints openly and constructively.
Wellbeing frameworks that prioritise emotional support and debriefing.
Indemnity structures that acknowledge the human, not just legal, dimensions of risk.

As part of this shift, there is also room and real need for innovation. From modern onboarding models that prioritise emotional readiness, to the use of digital tools that make support faster and more personalised, forward-thinking approaches can ensure that the systems surrounding GPs evolve alongside their needs. It’s not about replacing empathy with efficiency but about combining the two more intelligently.

Not every complaint is a sign of failure. Sometimes they are a mirror, simply reflecting system level shortcomings. Sometimes, they stem from communication mismatches rather than clinical errors. By reframing complaints as opportunities for growth while still protecting the mental health of practitioners we can cultivate resilience without resorting to blame.

GPs carry a unique kind of burden: the weight of expectation, the privilege of trust, and the ever-present scrutiny of a system under strain.

Fairness and compassion

The true cost of complaints can’t always be measured in legal outcomes or insurance claims. It’s measured in sleep lost, confidence shaken, and careers quietly altered over time. It is a silent burden, but it need not be a lonely one.

In my conversations with GPs across the UK, I’ve seen how deeply even informal complaints can wound not because of fault, but because of how much doctors care. That emotional toll often goes unseen, and too often, unsupported.

We must continue to advocate for a complaints culture that is fair in process, humane in tone, and grounded in genuine care for those delivering care themselves. When we listen, support, and stand with our profession not just as providers, but as people we can help restore not just confidence, but the joy and purpose that first brought so many into medicine.

Let us keep building a system where complaints are met with fairness, practitioners with compassion, and the profession with the support it deserves.