“Some thoughts on complaints and their prophylaxis”

MEDICALBeing a doctor is undoubtedly a great privilege, but sadly working as one circa 2017 in large parts of the UK is becoming more and more difficult, stressful and unrewarding. But wait,  are these not just the ramblings of a cynic? What is the evidence for this? Well, if you look at some of the published statistics about the medical profession published by the doctors regulator, the General Medical Council (GMC), there is some rather grim reading contained therein. For example, at the very start of the State of Medical Education and Practice in the UK (2016) report [1], it is stated that, there is a state of unease within the medical profession across the UK the signals of distress are not always easy to interpret but they are unmistakable. When it comes to a specific example of this unease, revolving around complaints, the bane of workers everywhere and not just doctors, there were apparently 8269 of these mad about doctors in 2015 with 5% leading to warnings, 6% to undertakings and 7% leading to erasure or suspension. Most (two-thirds) were closed with no further action and 14% were closed with advice. Most complaints (68%) came from the public, 9% from other doctors (!), 6% from employers and interestingly, 6% from self-referrals.

Why am I boring you with these statistics? Well, as a doctor myself I am aware of doctors vulnerability to complaints, and may years ago I recall one sage and possibly jaded senior colleague telling us fresh-faced juniors as we were then, to expect to be complained about. Not by patients necessarily, but more by colleagues and managers. I cannot recall what advice was proffered then, perhaps none was, but thinking now about colleagues with formal complaints makes me realise how lucky I have been not to have been a person of interest to the GMC. Yet I have observed complainers and complainants from afar and have drawn some conclusions, which I will now share. Firstly, many complaints I have witnessed are political, due to system failure or clash of egos, and really do not merit long-winded investigations, formal action and the inevitable damage this causes. Actual negligence is rare, and most doctors I know are competent, knowledgeable and usually safe. There are exceptions, which everyone knows about, and terms such as Dr Do-Little are not always pejorative.

Sometimes complaints are vexatious, and these are particularly toxic, as the agenda can become personal, inflicting irrevocable harm to the intended target: Here, another GMC document, ‘Doctors who commit suicide while under GMC fitness to practise investigation [2] makes for sobering reading. I have personal knowledge of a colleague who committed suicide under such circumstances some years ago and while suicide may be an extreme and devastating outcome, many colleagues have experiences stress-related health problems, left the profession, or even the country as a result of complaints. Even if found innocent, reputations are ruined, complainants do not seem to ever be brought to justice and doctors, especially those on the front-line, remain a vulnerable group.

But there are things that can be done, and thinking like a lawyer, while potentially anathema to many doctors, provides some useful insights. One could assume that complaints may arise at any time and for any reason, fatuous or not, so it is best to be prepared. Good interpersonal and clinical skills clearly help here, as does knowledge, experiences and, well, luck. Good record keeping is a must, especially at five to five on a Friday afternoon after a long week when a delicious, work-free weekend awaits and one is in a hurry to escape on time and avoid an extended after-hours stint. Knowing hospital, local and national policy helps, not just about clinical matters, but medical negligence, consent, communication, duty of candour etc“ there is loads of useful guidance here from the GMC, NHS, ACAS, Royal Colleges to name a few.

If you are unfortunate enough to be the subject of a complaint, dont panic, dont keep this to yourself, share with a trusted colleague, make sure you are aware of the nature of the complaint, seek advice and dont over-react. Most complaints have no merit and will not progress, and pre-arming yourself with knowledge and experience of conflict resolution and complaints handling and following GMC guidance such as ‘Duties of a Doctor [3] well in advance can and will pay off. If in doubt, always seek advice, consider/suggest mediation or other forms of conflict resolution, and eventually â hopefully – it will all go away

[1] General Medical Council 92016), State of Medical Education and Practice: Overview, page i. <http://www.gmc-uk.org/SoMEP_2016_Overview.pdf_68137053.pdf>

[2] General Medical Council (2014), Doctors who commit suicide while under GMC fitness to practise investigation. <http://www.gmc-uk.org/Internal_review_into_suicide_in_FTP_processes.pdf_59088696.pdf>

[3] <http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp>

By Dr Russell Foster Consultant psychiatrist with extensive medicolegal, managerial and judicial expertise, medical consultant

“Some thoughts on complaints and their prophylaxis”