Dr Shaba Nabi on the ‘damaging’ impact of patient complaints
Ask any clinician and they will convey a similar sentiment – that there is nothing more crushing than receiving a patient complaint.
Its impact will vary based on whether it is a verbal moan or a full-blown medicolegal assault, but the same emotions are triggered. These emotions of self-doubt, anger, frustration, despair and depression play out in most of us throughout the process of addressing a complaint, yet we receive little coordinated external support in such situations.
When the effort required for the patient to submit a complaint is minimal, it’s hardly surprising that we are flooded by a litany of niggles and gripes, which are effortlessly captured by practice support staff. The lack of effort on the part of the patient is mirrored by the lack of patient responsibility for their own health.
I was recently sued by a patient* following failure to follow up on their non-attendance for a routine scan, which resulted in a delay in the diagnosis of their cancer. I received notification of this non-attendance but I didn’t chase it up as I assumed a patient with capacity would self-present if their condition was worsening. Yet medicolegally, that assumption was incorrect because the ethical principles of patient autonomy do not extend to self-responsibility and accountability for their own health.
Despite this obvious mismatch of responsibility, my indemnity organisation chose to settle out of court, and I chose to accept this. I had already exhausted my time and emotions, so this scenario can be played out repeatedly; the lack of rebuttal encouraging further complaints.
As a GP veteran, I feel adept at brushing off these emotions, picking myself back up and getting back on the hamster wheel. But for others, the consequences can be fatal. At best, an adverse incident may lead to a period of sick leave followed by the shackles of defensive practice. At worst, it can lead to burnout, early retirement or even death. This is the reason for the term ‘second victim’, which captures the immense impact these complaints and adverse incidents have on all clinicians.
But what may be even more damaging than a one-off significant event is the constant drip-feeding of patient angst we are subjected to. And this is more likely to come following considerable time, effort and care offered to the patient. There is often a degree of personality disorder associated with these interactions, but this doesn’t change the outcomes of frustration and demoralisation for all concerned. And we can’t just terminate the doctor-patient relationship whenever this happens.
What we desperately need is for the law to step up and stop treating patients like children when it comes to their own health, so we can have adult-to-adult transactions. This includes rejecting any unfounded and unreasonable complaints about things that the GP has no influence over. I have to give the same time and attention to responding to complaints about interventions not funded, or normal blood results, as I do to any errors we have made.
The entire NHS complaints system needs a radical overhaul, which should include consideration of a no-fault compensation scheme, with lessons learned from the process in New Zealand where litigation has been reduced. Otherwise, we will continue to haemorrhage a workforce who are being crushed by complaints.
*Details of the case have been changed to protect patient confidentiality
Dr Shaba Nabi is a GP trainer in Bristol. Read more of her blogs here