Like death and taxes – a personal defence strategy for complaints

My practice manager is a lovely guy, but whenever he knocks on my consulting room door, I am gripped by a deep and unshakeable sense of dread. What have I done, who have I killed, or WORSE, have I received a complaint?!

Clearly, this reaction isn’t healthy or rational, but I wager I’m not alone in my slightly overexaggerated fear of complaints.

Of course, it is entirely appropriate that patients have the right to complain. It is also clear that patients are increasingly availing themselves of this right, with NHS digital reporting a 37% annual increase in complaints against GPs last year. Hopefully, some of these complaints will lead to important lessons being learnt and services improving. But we all know that complaints can also have a significant negative impact far beyond the workload associated with dealing with them, affecting the way we practice medicine, our sense of self, our personal lives and mental health.

Another consequence of this increase in complaints means it really is a matter of when, rather than if, we receive a complaint, with nearly all GPs being on the receiving end during their careers. 

Given this near inevitability, perhaps we need to focus less on avoiding complaints, and more on how to manage when they occur. Vernon Needham describes this as developing a ‘personal defence strategy’ in his opinion piece in the BJGP.

When we first receive a complaint, he reminds us to read it, read it again, then pause, and have a break. Often when we come back to the complaint, it usually won’t seem as bad as our catastrophising brains first told us. We should also always expect resolution to take far longer than we would like and try to ‘park’ thinking about the complaint when we can. Candid and honest reflection is crucial, especially after the initial distress, guilt or anger subside, but excessive rumination is not our friend. Likewise, we need to understand that our indemnity organisations will be trying to close the matter as quickly, and cheaply, as possible, often at the expense of our pride. Try to remember, it’s a process, not personal. 

Vernon also identifies three important ‘nevers,’ to ignore at our peril:

1. Never put anything about the case or complaint on social media.
2. Never retrospectively amend clinical records.
3. Never reflect using third party identifiable information.

Learning to apologise well is also a really important skill, albeit one many of us struggle with. NHS Resolution provides helpful advice in their Saying Sorry Guide, which can be neatly summarised as ‘don’t apologise like a politician’, and the BMA provides further practical guidance here.

Seeking advice and support is also crucial, be that via your PM, a trusted colleague, your MDO, the BMA and/or your LMC. Also consider the support mechanisms around you, such as friends and family, making sure you don't inadvertently breach confidentiality. Your own GP, Practitioner Health, the BMA doctor support service  and Second Victim Support can provide objective advice, support and referral if needed. 

Much like tax returns, it’s tempting to bury our heads in the sand when it comes to complaints. But have a think about your own personal defence strategy, remember you are never alone, and it might just make things just that little bit more manageable when the inevitable happens.

Dealing with complaints is just one of the topics covered in NB ‘New to GP course’. We also cover time management, ‘sleepless night’ clinical scenarios, and the nuts and bolts of surviving as a GP, with tonnes of tips from the NB team thrown in for good measure.  So whether you qualified 2 months or 20 years ago, we hope you’ll join us on the 24^th November, or via catch up. 

And in the meantime? The final word has to go to Practitioner Health, from their excellent Guide to Complaints and Investigations:

‘A complaint does not mean you are a bad doctor. It does not negate all the good work you have done in your life. It does not make you a bad person. This is more about the system we are working in, rather than any personal failing on the individual.'