“The patient will judge your competence based on your communication style”


it may be difficult even with our best efforts. Although we offer a 24-hour turnaround, this may take a bit longer if it’s a very stubborn stain so pleaselet us have an extra day’. Well, I knew it would be difficult for them but they have obviously tried really hard and you can hardly see the stain now.” So both cleaners tried equally and failed


equally to remove the stain. In the first scenario, this was the fault of the – obviously incompetent – cleaners. In the other it was just a particularly stubborn stain.


How do yourespond to dissatisfaction? Say you find yourself dealing with a patient who has survived his emergency repair of an abdominal aortic aneurysm with his kidneys, cerebrum and myocardium still more or less intact and who is complaining bitterly about a minor stitch abscess. You are on your last of seven night shifts and it’s 4 am. The temptation is to tell the patient not to be so pathetic and he should be grateful he is still alive. While you might feel better, the patient will almost inevitably escalate his grumbles. Only a minority of dissatisfied people are


looking for compensation or retribution; the vast majority will settle for something called “empathetic validation”. This means having a good old grumble while someone mops your fevered brow, listens to your woes and agrees with you how awful it has all been.


Imagine you have come home after the train


journey from hell: no seats, no air conditioning, no information, missed connections and a 45 minute walk home from the station in the rain. How do you feel if your partner greets you with: “I’m glad you are back at last. I’m just off to badminton. Oh, by the way, the cat has been sick and I’ve not had time to clear it up.” What you wanted to hear was more along


the lines of: “You poor thing! What a dreadful journey! Sit down here and I’ll bring you a drink – something long and cool with tinkling ice- cubes – and you can tell me all about it.” Perhaps a Singapore Gin Sling is not


necessary for the patient with the aneurysm but you do need to acknowledge the problem, which is very real to him. Empathise with the patient by showing how sorry you are that he is upset and let him tell his story while you (actively) listen. The fundamental structure is something like: “I can see that this is a very serious issue


for you Mr Smith. I am very sorry that this has not worked out as we both hoped. Please take your time and tell me what the problems are and then we can talk about how we can set them right.” Next you should reassure the patient that his


concerns have been heard and understood. Do this by active listening and feeding back short summarising sentences along the lines of: “Let me check I have understood you correctly; you are worried that the stitch


abscess might be an indicator that your graft is infected. I can understand that this would be very worrying.”


A welcome ear It’s not difficult to find people who are very good indeed at empathetic validation. They often have a sign on the door that says something like: “Have you been injured in a medical accident? Come in and talk to a solicitor today. We guarantee that all your damages will be paid to you!” The attraction of a free half-hour with a solicitor is understandable. Out comes the patient saying how competent and respectful the solicitor is having also explained how it is well worth trying to obtain some compensation. Reinforcing the view that the doctor is a complete monster is for a solicitortime well spent. So if there is one single secret to dealing


with complaints and preventing lawsuits, it is to be at least as good at empathetic validation as the lawyers and to deliver it first. Of course, some complaints will not be


resolved by empathetic validation but it’s always a good start. Remember that 80 per cent of complaints are made by 20 per cent of patients and you will always encounter people who will remain unhappy no matter how you answer their dissatisfaction. But the “take-home” message here is that managing expectations beforehand and dealing promptly and empathetically with complaints when they happen will resolve the majority of problems before they can progress any further.


Mr Des Watson is a medico-legal adviser at MDDUS


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