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The fear of complaints



As doctors, we are exposed to a diet of case law that feeds our fear of complaints, influencing how we practise. The recent case of a 20-year-old woman with spina bifida suing a GP for not having prescribed her mother folic acid in pregnancy shook us all so hard that, unprecedentedly, this column and Copperfield’s – published at the same time – address the same subject. So GPs are not only responsible for the living, breathing person in front of them; they are also culpable for disabilities in the unborn, which have nothing to do with public health measures or personal responsibility. 

In case law as a whole, the lack of personal responsibility is particularly galling. I have always believed rights come with responsibility – apparently not in healthcare. I recently settled out of court for a case involving the misfiling of a result; the fact the patient took no responsibility for events leading to the error was irrelevant to the lawyers. This came 20 years after another out-of-court settlement, when I was sued as a GP trainee. 

What helps me come to terms with complaints and litigation is the recognition that I am human and might make mistakes. But not all complaints are rooted in error, so we must accept them as a normal part of life, and our jobs.

Much of the fear of complaints stems from our personalities. Many of us are perfectionists and our jobs form the foundations of our self-esteem. A serious complaint could easily lead to a cascade of catastrophic thinking about our self-worth and whether we are up to the job. Most of us find it hard to separate the adverse incident or complaint from a global assessment of ourselves. Instead of appraising ourselves as ‘good enough’ we are constantly trying to be better – which can only lead to burnout. 

But the normalisation of complaints in a no-blame learning culture requires significantly more than just a reset of your cognitive framework. On the most basic level, it requires a practice team that will accept its flaws and create an environment of support, rather than scrutiny. It requires GPs in senior positions to own their imperfections so the entire team can see that the error doth not make the man. 

I have been the complaints lead at my practice for at least six years and have written hundreds of complaints responses on behalf of others. I hope they feel supported. Sadly, a supportive practice is not enough. GPs are the victims of multiple jeopardy – from lawyers, NHS England, the GMC and even the police. I’ve frequently seen complaints dropped by one organisation, only to be pursued by another. These regulatory bodies expect us to be superhuman. So or brains are functioning in chaos – do we aspire to the ideal demanded by society, or do we ignore it, and accept complaints, and two to three medical negligence claims in a career? 

The first path will lead to anxiety, insomnia and burnout. The second will be met with lots of distressing complaints. But like many things in life, if you subject yourself to it often enough, you gradually become immune. 

I know which path I prefer, but do you?

Dr Shaba Nabi is a GP trainer in Bristol.

Read more Dr Nabi’s blogs here 

READERS' COMMENTS [6]

Patrufini Duffy 17 December, 2021 10:32 pm

The system plays into the hands of the irresponsible and the narcissist. Not the carer. Blame is a weak excuse for lack of one’s own ability to take control and act accordingly for one’s own life. Western privilege believes that it is someone else’s dirty work to do and to tell. You must be the encyclopedia for the lazy. And law and politicians are dirty hands, meddling in the purity of nature, trying compassion and the powers of Universal consequence.

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nasir hannan 19 December, 2021 5:57 pm

You are a legend shaba, you always have been and always will be! Don’t ever forget the 1000’s that you have helped and that are truly grateful to you for how you have helped their lives.
All the best to you

David Riley 20 December, 2021 12:46 pm

I took early retirement eight years ago. Until the day I die at the back of my mind will be the fear that I may face a complaint whether through something like the folic acid case or because I placed a hand on the hand of a grieving or worried patient and am now accused of inappropriate contact through some money chasing grubby solicitor.

Cameron Wilson 20 December, 2021 1:08 pm

One of the best ways of making the NHS more efficient would be to address this matter. How many times do you hear of patients being neglected in no small part because mindless paperwork has to be done to give the impression that all’s well! How much time is wasted on back covering at the expense of common sense! How many investigations are done practising defensibly! The list goes on and the cost goes up,it certainly isn’t in the remit of the workforce to change things when they are personally slaughtered but you would think that some politician might for once do us all a favour and sort this out!

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Patrufini Duffy 20 December, 2021 5:30 pm

Yes Cameron. All GPs are ecstatic on a Monday morning, to see the sigmoidoscopy report as normal for yet another barn door IBS and that thyroid test and ECG normal for that single palpitation whilst drunk, but was so worrying when they went to sleep intoxicated, that they convinced themselves that they’d have sudden cardiac death like a footballer. And the tired patient who just couldn’t be bothered to sort their social life out, but reassuringly had a normal Hb and B12, because that’s what the magazine said was wrong. And for now, this month, they feel medically at (dis)ease until the next psychosomatic issue arises or threat of a complaint if you don’t do what my mind says is wrong. Keep testing until you find absolutely nothing.

Josef Kuriacose 21 December, 2021 9:22 am

The harder we work and the more patients, tests, letters, prescriptions we deal with each day, the more likely we are to make mistakes or provide hasty care. We doctors do not define safety as pilots [ for example] do. If we did define safety, we would have far more time to deal with matters safely and more time to spend with patients and thus reduce complaints. This is an urgent matter that the BMA needs to address, otherwise its workforce is working under enormous stress.
The other area we do address is that of staff shortage which leads to extreme stress and inability to cope. Dr Bawa- Garba is an example of this. She was working without rest, food or drink in a situation where there were periods of time missing 4 doctors, This work ethic shows exceptional dedication and commitment to her job and patients. Yet she is convicted of neglect of her duties!! That judgement is against all natural justice.
Here is an area that needs addressed. If a single doctor is missing from a roster, then the care must be classified as crisis care, where normal expectations of health care cannot apply.