Responding to Complaints in Your Practice

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1 Responding to Complaints in Your Practice

2 Contents Frontline and formal complaints 3 Why do patients complain? 3 How doctors respond to complaints 4 Your responsibilities 4 Avoiding complaints 5 Avoiding complaints is not the same as practising defensive medicine 5 Initial response to the complaint 5 Dealing with complaints 6 Outcomes to consider 6 Look after yourself 7 Find out more 7 Responding to Complaints in Your Practice Complaints can play a part in most professionals lives, albeit not a very welcome part. It has been estimated that about one in twenty doctors receive a formal written complaint each year, and countless others will know of a grievance or other expression of dissatisfaction within their practices. In the context of the number of services provided by doctors every year, very few complaints result in a formal complaint, and less than one in ten of these progresses to any disciplinary action against the medical practitioner. These figures emphasise that, while complaints against doctors are relatively frequent, formal disciplinary action against them is uncommon. Regardless, the receipt of a complaint may come as an unwelcome surprise, but the anxiety of dealing with it will be lessened by having good procedures in place and by knowing how to seek assistance. 2

3 Frontline and formal complaints We call complaints received by you or the practice frontline complaints. They may be about the practice itself: waiting times, the way a receptionist spoke to the patient, the fees or other irritant factor ; or they may be about your own or a colleague s care. Many complaints can be resolved directly within the practice by being dealt with at an appropriate level of authority and by being taken seriously. The effectiveness of direct resolution may determine whether the grievance will end there or will go further through a formal complaints mechanism or to a solicitor s office. Why do patients complain? Patient complaints reflect a patient s subjective impression of the care they have received. Complaints can occur in the absence of any error or adverse treatment outcome, but may arise because expectations have not been met. This is not only about medical treatment, but also about aspects of communication that may have upset the patient or their family. For some, a poor outcome or an adverse event may generate such intense feelings of anger and distress that patients or their family may feel that someone should be blamed for the outcome. However, as we all know, unexpected and unwanted things do happen and it may not be anyone s fault. At times, it is difficult to separate the desire for accountability and responsibility from the negative connotations of blame and retribution. When one is in a state of grief or shock, blame may be the direction the mind takes in order to deal with it. Patients and their families identify the key reasons for complaints as: Wanting an acknowledgement that what happened to them or their loved one has affected them deeply For whatever happened to them to not happen to anyone else For people to be accountable for what happened To obtain information about an episode of care that they have been unable to access or understand. While some complainants may wish for more, most will be satisfied if the above are met. The key is to establish what the complainant wants by making a complaint: it may be an apology, access to a report or further explanation of decision-making, or reassurance that whatever contributed to the incident has been remedied. Alternatively, they may wish to see a receptionist fired, a doctor struck off, a medical practice closed down. How you respond will be determined by the nature of the complaint and what outcome is expected. MDA National can assist in making such determinations. 3

4 The MDA National Claims and Advisory Services team can offer assistance on how to deal with complaints. How doctors respond to complaints Some react with surprise, anger, disappointment, shock or dismay. Others react with cynicism, dismissiveness or frustration. The critical point to understand when responding to complaints is regardless of whether or not you believe the patient has a justifiable complaint, they are aggrieved, and as the target of that grievance it is up to you to deal with it. A very common response is to refute the allegations, at least in your own mind. It is a normal thing to do, to deny, pass the blame on to someone else, to find another explanation, re-interpret the incident, or blame the patient. It is more constructive however to reflect on why there was a complaint and how best to resolve or address the matter. If you need support and advice in dealing with your own responses to a complaint, MDA National is here to help you. Your responsibilities Your professional indemnity insurance policy obliges you to notify MDA National of complaints received by a complaints body or Medical Board or of an event that may lead to an investigation or inquiry We strongly advise you to seek advice before responding to a complaint in writing Always seek advice before responding to a formal complaint from the Medical Board or complaints body If you receive a complaint from a complaints body or Medical Board, never contact the complainant direct. This may be construed as coercing the complainant to withdraw the complaint, which is prohibited under complaints legislation. However, a complaints body may direct you to prepare a response, but seek MDA National s advice before you do so. 4

5 Avoiding complaints The key is to keep communication open and be available and responsive if you become aware of patients who may be dissatisfied or concerned about the care provided at your practice. An open and trusting relationship established from the outset will better equip you to be able to resolve concerns early, and achieve greater patient acceptance and understanding if things go wrong. One of the main sources of complaints is unmet expectations. Resolve unrealistic expectations at the outset and ensure patients have a clear understanding of their own illness, the options for treatment, the possible effects of treatment, the benefits and risks, the timing and cost, and above all, the understanding that medicine cannot achieve the impossible, or miracles. Patients who understand they too have a responsibility to look after themselves and follow your advice (or discuss with you why not) will see the relationship as more of a partnership than a power imbalance whose only remedy when dissatisfied is to complain or sue. Avoiding complaints is not the same as practising defensive medicine Giving in to patient demands, declining higher risk procedures due to fear or avoidance, ordering more tests, specialist referrals or medicines than are clinically indicated, are all signs of defensive medicine. It is better to practise in accordance with your professional judgement and confidence than be driven by uncertainly and fear. Initial response to the complaint How you respond to a complaint will influence whether it will progress any further and the direction in which it may progress. These are some suggested strategies for dealing with complaints: Ensure complaints are dealt with at an appropriate level of authority Staff should be adequately trained in communicating with dissatisfied patients Assess the complaint to determine how best to deal with it and establish the basis for the complaint Respond to the complaint early and in a spirit of resolution (seek advice when you need to) Where appropriate, arrange to meet with the complainant to address their concerns Establish what they expect to achieve by making a complaint. Where necessary, inform the patient what information you need to gather in order to inquire into their complaint, and keep them informed if this will take some time Ensure that ongoing care is in place for the patient as required, provided by your practice or another suitable practitioner Ensure that the patient feels heard : listen to their concerns, ask questions and paraphrase to clarify, provide information or tell them this will be sought for them, summarise and agree on the next action If the complaint is from a patient s relative or other source, ensure you do not breach your patient s confidentiality. In these circumstance, a verbal or written authority from your patient should be obtained before providing a response to the third party Keep notes of all meetings, phone calls, correspondence in relation to the complaint, and keep these in a file separate from the patient s medical file. Before putting anything in writing, or committing to an agreement, contact MDA National for advice. 5

6 Dealing with complaints Sometimes, due to the complexity of a complaint, the parties involved and their expectations, a complaint cannot be fully resolved at the time it is initially received. The Claims and Advisory Services team can offer assistance on how to deal with the following: The suitability of a face to face meeting with the patient in order to progress the complaint. This provides the patient with full access to you and your staff, and can provide you with useful visual cues. It may be appropriate to suggest that the patient attend with a family friend or relative. Identifying the contributing factors to the patient s dissatisfaction such as a misunderstanding about the nature of their illness and its effects, or of treatment. A low level of health literacy or social circumstances that were previously unknown may have also contributed. Understanding these will obviously influence how you deliver your response and avoid further conflict or dissatisfaction. Addressing all issues of concern that the patient has raised, and expressing regret for their circumstances without any admission of liability on your behalf. MDA National will provide this assistance and advice before you meet the patient. Keeping the patient informed of any ongoing inquiry into their complaint lack of information can be construed as lack of interest or action, which can add to the grievance. Avoiding emotive language or showing any frustration during dealings with the patient. Involve patients in seeking solutions. Outcomes to consider Once a complaint has been dealt with and resolved, it is useful to reflect on what the complaint means for the practice. Would training in managing difficult encounters with patients be useful for you and staff? The Risk Management team can provide resources or help you find a suitable program. Are there any changes that need to be made in the practice? - practice systems - documentation - maintaining privacy and confidentiality - consent for treatment - communication The Risk Management team can assist you review these key areas. It is also useful to understand that the outcome of a complaints process may not always be satisfactory to all parties. For instance, an adverse event may have harmed a patient and regardless of a wellconducted complaints process, the outcome cannot be undone. Or it may be a matter of agreeing to disagree, as everyone has their own perception of events and their effects in spite of opportunities being offered to explain and provide information. 6

7 Look after yourself First, avoid taking a complaint personally to the detriment of your health and work performance. A complaint is generally a rare event so do not allow it to detract from the satisfaction in your care that you provide all your other patients. If however there is a pattern emerging, consider what may be behind this and seek some help or advice in identifying and remedying the underlying causal factors. Second, if encounters with patients become aggressive or out of hand, you need to consider your own safety and your staff s. Give a clear message that aggressive behaviour is not acceptable, do not enter into arguments and do not be intimidated by threats of legal action. Work with your staff to establish a safety protocol within the practice, so you are all clear on where to draw the line with unacceptable conduct and how to deal with it. Seek advice on how to manage ongoing threatening behaviour, or call the police if you fear an imminent threat. Third, if you have received a formal complaint or claim, it will help you if you are familiar with medico-legal processes. Please ask your claims manager for a brochure and ask for clarification if you need it. Understanding the process will help to allay anxiety. And most importantly, MDA National can provide support to Members experiencing stress through its Doctors for Doctors Program, or speak with your GP, a trusted colleague or call the Doctors Health Advisory Service in your state. Find Out More For more information visit or contact or For advice in the case of an adverse event or complaint, call our Medico-legal Advisory Service any time, every day on

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