Think that only incompetent doctors get referred to the GMC? Think again…

Dr Richard Stacey looks at a wide range of factors that could lead to a GMC hearing...

Every day, newspapers are full of the latest “shock statistics” in their headlines. We hear details of “record numbers of businesses” failing in the tough economic climate; some lucky shops reporting a “record number of customers” in the weekend before Christmas; and of course we’re all familiar with daily weather reports which claim we are in the grips of “the coldest winter on record”.

But when the GMC announced in September last year that it received a record number of complaints against doctors during 2011, that was one statistic guaranteed to make doctors across the country take notice.

For those of you who missed the headlines, the GMC said complaints had risen by 23% on last year – an unprecedented amount by anyone’s standards. In total, 8,781 complaints were made against doctors in 2011; up from 7,153 in 2010. What’s more, it also said the volume of complaints received has been rising steadily since 2007.

Before becoming a medicolegal adviser, I spent about 10 years working as a GP and, although most of the time things tick along nicely, occasionally a GP will receive a complaint from a disgruntled patient.

Most doctors consider these extremely difficult and stressful situations to be rare. So – what does the latest GMC report tell us? That patients don’t value the relationship they have with their GP anymore? Or maybe we are becoming worse at our jobs?

Actually, neither. Results from a Which? survey published in September revealed that 80% of people consider doctors to be trustworthy – an accolade only topped by the nursing profession, who were rated trustworthy by 82% of people. Dr Clare Gerada from the RCGP reassures us we are not becoming less able to do our jobs, instead claiming that an emerging complaints culture is the driving force behind the rise in complaints.  Her view – and mine, for that matter – is that the rise in complaints just reflects the challenging environment that doctors today face, rather than a decline in our collective performance.

So let’s consider this emerging complaints culture and what we can do to avoid falling victim to it.

In its report, the GMC says there are three main reasons why patients complain, namely if they have concerns around their treatment or diagnosis; if communication failures lead to the patient feeling as though they haven’t been listened to; or if they feel the doctor has acted in a rude manner towards them.

"Dr Clare Gerada from the RCGP reassures us we are not becoming less able to do our jobs, instead claiming that an emerging complaints culture is the driving force behind the rise in complaints"

The first issue here centres around professionalism; it’s a simple case of ensuring you follow through with any investigations or referrals you promise and routinely consider differential diagnoses if symptoms persist.

We know from experience at MPS that poor communication can be a reason in itself for complaints being raised. Even if you have examined the patient thoroughly, made the right diagnosis and prescribed an appropriate course of treatment, if you don’t tell the patient what you’re doing along the way, it’s not surprising that they may feel “out of the loop” and disconnected from you, and this can lead to misunderstandings and complaints.

It’s definitely worth spending some time thinking about how you come across to patients; consider the way you position yourself, your choice of words and tone of voice. Are you doing all you can to put your patients at ease and ensure they understand the reasoning behind your decisions? Our experience shows us that developing good communication skills will improve your clinical effectiveness and reduce the risk of being on the receiving end of complaints.

I think we all need to be better at managing the expectations of our patients, too, if we want to curb this worrying trend of rising complaints, and this is something that must be tackled early on in a consultation. If you think a patient’s demands for treatment are unreasonable, or if they harbour unrealistic expectations about the speed or extent of their recovery, you must explore and address these concerns.

Above all, if you do receive a complaint, don’t react defensively; instead, seek MPS advice. So often, we see a letter of response that has been written in haste (and in anger) lead to an escalation whereas a measured response, including an apology can often defuse the situation. It’s a common myth that an apology is an admission of guilt; in fact, when issued in a genuine manner, it can stop a difficult situation escalating out of hand.

Obviously, complaints come in all shapes and sizes and no one can predict when one will be made; but following through on investigations, communicating effectively with patients and making an effort to keep their expectations in check will stand you in good stead for avoiding the trap.

I’d be interested in hearing your thoughts on how to defuse complaints from escalating… ensuring of course you don’t disclose any patient details, just lessons you’ve learnt.