Recent statistics from a Medical Protection survey of GPs and a YouGov survey of the public show that both parties believe complaints should be seen as an opportunity to learn and improve a GP's practice.
It is encouraging that GPs see complaints as a positive learning tool, particularly if they have previously been the subject of a complaint, or indirectly involved in one - they may have suffered enormous stress and viewed it as a negative experience.
The survey highlighted how common place complaints are, with 94% of GPs having been the subject of a complaint and more than two thirds (67%) stating that they viewed the complaint as an opportunity to make improvements to their practice.1
Interestingly, this mirrors the reason that patients often make a complaint. Well over half (69%) of the public surveyed who were asked about what they would expect to achieve by making a complaint, said they wanted the GP to learn from the mistake and to take positive action (such as training) to avoid a similar situation.2
Openness
Medical Protection has always encouraged GPs that an essential part of responding to any complaint is to demonstrate how you have learned from the mistake, or how you plan to. Telling the patient, for example, that you have reviewed the reason for their complaint as a significant event and discussed it with your partners to learn from it, can prevent a patient taking the complaint further.
An equally important part of the response is being open and honest about what happened. Patients who make a complaint are most likely looking for a truthful explanation as to what happened. Hiding the truth, or giving that impression could inflame the situation and increase the likelihood of the complaint escalating.
As an individual GP it may feel like achieving a culture of openness is impossible. However, there is a strong evidence base identifying communication strategies that can be used to prevent complaints from arising, for example being able to manage a patient’s expectations.
At Medical Protection we see that unfulfilled expectations lie at the root of almost every complaint raised by patients, whether those expectations are realistic or unrealistic. One habit to develop and use in every consultation is to ensure that expectations are elicited.
Managing challenging interactions
Dealing with challenging patients will impact on the stress levels and morale within the practice, which in turn can negatively affect patient care and increase the risk of a complaint. Several factors contribute to making a patient interaction challenging, so understanding the reasons behind these interactions can reduce their frequency.
One of the first key steps in dealing with difficult interactions is realising that 'difficult' is a statement about our discomfort rather than the patient.
If you ask several different healthcare professionals from the same GP surgery who their 'difficult patients' are, while there will be some overlap, there will also be considerable differences both in terms of individual patients, but also the conditions they present with.
It is therefore more helpful to talk about difficult or challenging interactions rather than difficult patients. This is because it helps us consider a broader range of factors that contribute to the difficulty; in particular what we can do to help reduce the perception of that difficulty.
Acknowledging the patient’s position requires skills such as empathy, actively listening and understanding the patient, and reframing: choosing to consider alternative explanations for the person’s behaviour.
It is critical that the patient feels that the clinician fully appreciates their position. This must be done well, even if the clinician does not agree with the patient or feels uncomfortable.
When informing the patient of your position you should acknowledge the difficulty in the interaction, and explain the relevant personal and professional boundaries. When placing boundaries, it is most important to ensure that the motivation for imposing the boundary by the clinician is in the patient’s best interest.
The final step is discussing a way forward. Discuss the pros and cons of all the options and agree a solution that is acceptable to both the patient and the clinician. The patient should then be empowered to go forward with that solution.
Patient expectations
The commodification of medicine and change in societal expectations has resulted in patients having some unrealistic expectations about their health care. If those unrealistic expectations are left undiscovered and unchallenged, the setting is ripe for a complaint to follow as they are unlikely to be met.
Much of patient disappointment relates to unmet expectations. It is only logical, therefore, to build in questions designed to identify and manage expectations. As GPs you may need to change your consultation paradigm.
- Think…Why has this patient come today/what does this patient want/what matters to this patient?
- Not just… What is wrong with this patient and what do I need to do/what is the matter with this patient?
Whilst this strategy will never reduce the risk of complaints to zero, using it routinely could diminish the risk of complaint. If we are able to use complaints as an opportunity to improve our practice, rather than seeing them as a negative, we stand to benefit ourselves and to help our patients.
- Vanessa Perrott is head of education development and delivery at Medical Protection
References
- Medical Protection conducted a survey of 127 GP members in August 2016 to determine their experience of patient complaints.
- All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 2021 British adults. Fieldwork was undertaken between 2–3 August 2016. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).
