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15 May 2015

Complaints from patients are on the rise. It’s a shock when you get one yourself

How it feels for a doctor to receive a complaint from a patient.

By Phil Whitaker

Veronica came to see me on an urgent appointment. She was extremely anxious, convinced that there must be something seriously wrong with her heart. She had felt a pain in her chest for a couple of days but hadn’t thought too much about it until she mentioned it to her boss that morning. Veronica happens to work as a secretary for a consultant surgeon. He was concerned and had immediately phoned a cardiology colleague. Much to Veronica’s consternation, she was told to go straight to her GP to get blood tests and an ECG.

It didn’t take me long to establish the diagnosis – she was exquisitely tender over the joints at the ends of the ribs, a condition called costochondritis. It gets better with time and judicious use of ibuprofen. There wasn’t anything wrong with her heart and she definitely didn’t need any tests. I passed on the good news, wished her a speedy recovery and cracked on with the last patients of the morning.

The following week, my practice manager presented me with Veronica’s letter of complaint. In it, she described how I had made her feel “stupid” for coming to see me. My initial reaction was of surprise – shock, even – and defensiveness. I replayed the consultation in my mind. How on earth could she have misinterpreted our conversation and assumed I thought she was “stupid”?

Written complaints against doctors were infrequent when I started in practice in the early 1990s. Now, the average GP expects at least one a year. This almost certainly reflects an increased readiness to complain across our society, rather than a decline in medical care or communication.

Medical complaints are best understood in terms of four domains – the patient, the illness, the system and the doctor – all of which play a part in virtually every contentious scenario. Being human, I found it easy enough to identify the issues with the first three. Veronica was highly anxious when she consulted, which may have distorted her perceptions. As for her illness, although ultimately it proved to be something trivial, its cardinal symptom – chest pain – had caused it to be confused with serious pathology. The system was also contributory. Veronica wasn’t “officially” a patient of the cardiologist, so he had obtained just enough information to decide that she didn’t constitute an emergency, then had sent her off in my direction for a proper evaluation. He would never consult a cardiological patient without an ECG and routine blood tests beforehand; and he didn’t have the experience of general practice to appreciate that we perform investigations much more selectively.

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Naturally, I found it uncomfortable to confront the issues with the fourth domain: the doctor. Yet this is the only one over which I have any real influence. The acronym “Halt” is useful: hungry, angry, late, tired. Veronica’s emergency appointment had been tacked on the end of a long surgery that was, by then, running very late, with all the stress that this causes. I had consulted 18 other patients before her and it was getting near to lunch, so I was both fatigued and ravenous. As for anger, we all have our particular “hot buttons” – those things that instantly infuriate us. I remembered the irritation I had felt at the cardiologist blithely instructing that I do various investigations that were completely pointless, treating me like a junior house officer and heightening my patient’s anxiety in the process.

At the time, I tried to explain to Veronica why she didn’t need the tests that she had been told she should have. Being hungry, late and tired, I evidently didn’t handle my annoyance with the cardiologist well. It must have been apparent – if not in my words, then in my body language and tone of voice. Veronica must have perceived this as my being irritated with her, making her feel “stupid” for coming.

I sent her a letter of apology. Veronica’s costochondritis quickly settled. And I learned lessons that might help me manage a similar situation more adroitly in the future.

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