Dr. Clare Stapleton discusses the steps you can take to protect yourself against complaints.
There are times in a doctor’s career – no matter how competent or experienced you are – when things do not go according to plan or a patient will be in some way dissatisfied with the treatment they receive.
Handling these events effectively can make the difference between a swiftly resolved concern with a good ongoing doctor-patient relationship and the issue escalating into a claim or regulatory investigation.
Complaints, complications and critical incidents can have a significant impact on well-being. This can often be overlooked by doctors and their colleagues.
If you or a colleague have been involved in any case with a negative outcome, please do consider the health implications and the support available.
Complaints
The risk of a complaint from a patient exists in the private sector as much as in your NHS practice.
However, in private practice a complaint is more likely to come to you directly and you may not have access to the same level of support when responding.
A complaint may not always come in the form of a conventional letter. It is a common error to assume that a complaint made verbally to a colleague or a negative comment on social media, for example, deserves less attention.
Any negative description of the treatment a patient has received is a complaint and should be managed as such. We assist many private practitioners with guidance on responding to a complaint to improve the likelihood of a swift and satisfactory resolution and help to maintain your reputation.
Our guidance is based on ten key complaints-handling principles:
TEN KEY COMPLAINTS-HANDLING PRINCIPLES
- Be timely
- Acknowledge the complainant’s concerns
- Offer an apology, where appropriate
- Be open
- Avoid being defensive
- Reflect on the issues raised
- Explain, when appropriate, what action will be taken to prevent a recurrence
- Obtain independent oversight wherever possible
- Offer a meeting to discuss the concerns
- Take advice from your medical defence organisation (MDO)
It can be difficult for any doctor not to take a complaint personally and this can allow the complaint to adversely affect the doctor-patient relationship.
Paragraph 61 of the current Good Medical Practice 2013 states: ‘You must respond promptly, fully and honestly to complaints and apologise, when appropriate. You must not allow a patient’s complaint to adversely affect the care or treatment you provide or arrange.’
While it may be appropriate to offer a second opinion or an alternative clinician in some cases, caution should be exercised before ending a professional relationship with a patient while a complaint is unresolved, unless this is requested by the patient.
It is not uncommon for a third party to complain on a patient’s behalf; for example, a family member. Before responding, it is important to establish that you have appropriate consent in place to avoid the risk of breaching your duty of confidentiality.
Negligence threat
Complainants can use legal terminology such as ‘negligence’ within their correspondence. Fear of litigation may naturally add to the anxiety caused by receiving a complaint.
The use of the word negligence does not necessarily mean that a claim is inevitable; however, it is important to distinguish a clinical negligence claim from a complaint.
There are some indications that a complainant may be considering making a claim, such as a request for their medical records. This request can come from the patient, a representative or a solicitor.
If you are concerned that any complaint or incident may result in a claim, then it would be wise to inform your MDO or insurer at an early stage. This is important, as there are strict time limits in which a claim must be acknowledged.
All complaints should be discussed in your appraisal irrespective of whether they arise from your NHS or private practice.
Evidence of reflection on a complaint can certainly improve your position in the unfortunate event that a complaint is escalated by the private provider, your NHS employer or the GMC.
Complications
Complications can arise even from appropriately conducted surgery or medical treatment and can be stressful for the patient and the doctor involved.
The consenting process should include a discussion of all known complications or side-effects of material importance to the patient.
However, even if the complication was discussed pre-operatively, this does not alter the fact that there has been an unwanted outcome. The GMC makes clear a doctor’s obligation in Good Medical Practice paragraph 55: ‘You must be open and honest with patients if things go wrong. If a patient under your care has suffered harm or distress, you should:
- Put matters right – if that is possible
- Offer an apology
- Explain fully and promptly what has happened and the likely short-term and long-term effects
- As soon as the clinician is aware that a complication has occurred, it should be discussed openly and honestly with the patient and an apology offered for the fact that it has happened
An apology is not an admission of liability but a human response that demonstrates empathy toward the patient. This stance can go a long way towards avoiding a complaint or claim.
The GMC has separate guidance on a professional duty of candour, which gives practical advice and explains in more detail a doctor’s obligation to a patient when things go wrong.
Learning opportunity
There may be a learning from any complication that has the potential to change your practice and that of your colleagues. System errors and human factors can contribute to any complication as much as the actual conduct of surgery or treatment.
It is wise to consider whether a complication that has occurred meets the threshold for reporting on the private provider’s incident reporting system. Doing so offers the opportunity for learning. It also demonstrates a doctor’s openness and willingness to learn from such incidents.
Failure to do so may risk criticism for not complying with professional or contractual obligations.
If you are not sure whether a complication requires reporting, it would be wise to seek advice from a senior colleague or the patient safety team.
Complications in the private sector and your reflections on them should be discussed in your appraisal, regardless of whether your Responsible Officer is in the NHS or a private organisation.
Complaints and complications can arise for any doctor at any stage of their career. Appropriate action and a considered response can limit the potential for an adverse impact on a doctor’s professional welfare.
It is wise to seek advice from your defence body early and be mindful of your own health during the process.
Dr. Clare Stapleton is a medico-legal consultant at Medical Protection
