The right response

DOCTORS at any stage in their career can be the subject of a patient complaint. It is an experience no practitioner relishes, but it can prove particularly challenging for doctors in training who are often less aware than senior colleagues of how the process works.

There are many reasons why complaints arise. Often they are a result of care provision going wrong or when patient expectations are not met, while others are based on misunderstanding. They can range from very serious matters to quite trivial issues. At the root of much dissatisfaction are issues of patient communication/rapport. Complaint letters frequently make reference to a doctor’s failure to listen or care, with allegations of attitude problems and rudeness. Patient perception is an important factor to remember.

The NHS complaints procedure is formal and is set out in guidance for each of the UK jurisdictions, but all have similar elements. If a complaint comes directly to you, then it should be shared with your supervisor and complaints manager - do not attempt to deal with it alone.

A complaint may be written or verbal and, in the latter case, it should be noted and checked for accuracy with the complainant. The first response should be an acknowledgment by the complaints manager before a full response is provided later.

Complaints may come from the patient themselves or someone appointed by them, usually a close family member. Appropriate consent should be provided by the patient in these circumstances. After-death complaints may also be raised by relatives and consideration should still be given to issues of confidentiality. The GMC’s guidance Confidentiality - Disclosure after a patient’s death is a useful resource.

There are time limits regarding the submission of complaints – usually restricted to within 12 months of the date of incident or date of knowledge of a problem. If you are involved in a complaint you should be advised of this and given the opportunity to respond.

The next step is to prepare a written response, expressed in professional and appropriately conciliatory terms. This is something that can be discussed with your trainer and an MDDUS medical adviser.

Generally, the opening paragraph of any response will be a polite introduction with a suitable expression of regret that the patient had cause to complain. Next, a paragraph summarising how the complaint has been investigated can be helpful. In the body of the letter there should be a factual chronology setting out the sequence of events. This should be supported by the medical records and possibly information from other relevant sources – such as recollections from other staff involved, hospital letters, etc.

The reply must be honest and, where things did not go well or care fell short, this must be acknowledged. The response letter should address the matters of concern raised by the complainant and answer any specific questions.

Conclude the letter with an offer to meet the complainant if that would assist, and provide information about the next stage of the complaints process should they remain dissatisfied. In England, Wales, Scotland and Northern Ireland, the complaint would be escalated to the respective ombudsman for an independent investigation.

There is a role for local health bodies – such as Local Area Teams and health boards – to act as an “honest broker”. In addition, NHS England can act as complaint investigator in their jurisdiction. Patients may choose to adopt these routes if they do not wish to write to a practice directly.

In many cases a complaint will be successfully handled within the practice (“local resolution”) but sometimes the ombudsman is asked to investigate. All relevant correspondence, including letters sent by the practice, notes of any meetings, etc, will be requested and reviewed – the ombudsman has wide powers to seek documents including medical records.

After review the ombudsman produces a detailed report, stating whether the complaint is upheld, part upheld or not upheld. In cases where at least part of the complaint is upheld recommendations will be made. These can include offering an apology, carrying out audits, amending processes and in some instances financial withholdings (fines) are made against the practice.

Responsibilities of the trainee and trainer

In Scotland, complaints about trainees must be reported to NES; in other areas there may also be a requirement to inform the relevant deanery/LETB. A trainer would be expected to discuss any complaint with their trainee in an open and supportive way. Any lessons to learn should be highlighted and the trainee given the opportunity to reflect and if necessary improve their practice.

If a meeting is arranged with the complainant and the trainee is present they should be accompanied – usually by their trainer but possibly a fellow doctor in the practice. These meetings aim to resolve matters and need sensitive handling – most trainees would not have sufficient experience and should not be left to deal with matters alone. If you are named in a complaint always seek assistance about how to respond – this should be from your trainer but MDDUS advisers are also happy to help. We are very experienced in dealing with complaints and can review draft letters of response.

In summary

Even the best doctors can receive a complaint – they are not uncommon and are a part of your professional life that you should be equipped to deal with. Look objectively at what the complaint is about – be honest in any reply, including making appropriate concessions and apologies. And don’t forget to seek advice.

Dr Gail Gilmartin is a medical and risk adviser at MDDUS