10 FYi • Advice


WELCOME EAR


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Defusing patient complaints is far preferable to answering them later in court or before the GMC – so says MDDUS medical adviser Des Watson


expression of dissatisfaction that requires a response.” Not only is this usefully concise it also incorporates two important elements in the overall management of complaints: dissatisfaction and response.


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Patient dissatisfaction Two questions arise once you accept the inevitability of some patient dissatisfaction:


• What can you do to minimise the dissatisfaction?


• How can you frame a response that is most likely to satisfy the patient who has complained after an adverse outcome?


But first it is important to note that an


adverse outcome is one seen from the perspective of the patient and often there is no suggestion of error, negligence or threat to patient safety. Evidence from the Harvard Medical Practice Study has shown that about one third of complaints or lawsuits will arise from passages of care that were entirely straightforward. Secondly, the two questions above are not


exclusive to handling patient complaints. In the UK, the dissatisfied patient has a number of ways of escalating that dissatisfaction besides making a complaint. Some people will report the doctor to the GMC directly and for others the strictly legal route of a claim for


O ONE likes negative feedback – undeserved or otherwise. But it’s an inevitable part of being a doctor, unless of course you can claim perfection and even that offers no guarantee.


The NHS defines a complaint as “an


compensation is preferred. Doctors often grumble about ambulance-chasing lawyers and the complaints culture but these are preferable to leaving the patient with no alternative but more direct action. My chief attending surgeon in the USA was murdered by a dissatisfied patient about nine months after my overseas training period ended.


How do you minimise dissatisfaction? The short answer is to manage patient expectations or more succinctly – under-promise and over-deliver. Think for a moment about what a patient expects from the doctor. This is probably almost the same list as you yourself would expect from your dentist or accountant or even the garage servicing your car. You expect the following:


• competence (and for airlines and doctors among others, safety)


• respect • to be listened to • to be kept informed and given timetables. Let’s look briefly at these apparently simple


suggestions and think about how different ways of handling them can contribute to dissatisfaction. How do people assess the competence of their clinicians? How do you assess the competence of your garage mechanic? Do you check his qualifications and track record at fixing cars? Do you check that your GP is on the GP register? We all use surrogates for competence and in most cases, these are to do with communication style. So, in a way,


competence is the least important of the four elements listed above. The patient will judge your competence based on the other three communication issues: respect, being listened to and being kept informed. Imagine that a middle-aged woman has just


come back from the dry-cleaners with an expensive blue dress that still has a visible stain on it after the cleaners have laundered it. Which of the following two scenarios is likely to generate more dissatisfaction with the cleaners when the stain is still visible after collection? Scenario 1: “When I took the dress in last


week, they did not seem at all interested; they just took it and offered me a receipt. I am not even sure that they attached the stub of the receipt to the dress or just hoped for the best when I came back in to collect it. I was not at all surprised when the stain was as bad as ever. They did not have a clue what they were doing.” Scenario 2: “When I took the dress in, the cleaners asked to look at the stain. They asked what it was. When I could not tell them, they said: ‘It is a nasty stain which spoils a beautiful dress and we can see why you want to get it out.Because we don’t know what it is,


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