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.
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