Medicine - a bitter pill
Steve Ainsworth advises that dealing with patients' complaints is a stressful experience
Once upon a happy time doctors
buried their mistakes." That's one
fairy tale at least that's not true.
Believe me, I know. In one capacity or another I've spent the best part of 30 years listening to patients complaining about their
experiences of the medical profession and
attending hearings at which accused doctors
have, in varying degrees of defiance or dejection, been asked to account for their acts and omissions.
Medical students will just have to face up
to it, being a doctor is a dangerous profession.
When I was young I often heard doctors
moan about something they called "double
jeopardy." What they meant was that not only
did they risk being sued for their failings but
they also faced the prospect of being hauled
before the General Medical Council.
When I knew a little more I realised that it
was actually much worse than mere double
jeopardy. The police may be brought in, for
example over a suspicious death - a risk more
likely than ever in this post-Shipman era - and
then there are NHS disciplinary hearings.
A complaint made by a patient can be a
time consuming and frightening experience.
Even a relatively simple case can have a long
run. Take a complaint against a general practitioner, for example. General practitioners are
supposed to have an in-house complaints procedure so the first stage of a complaint is dealt
with inside the practice. That may involve
meeting the complainant and writing letters
to answer his/her criticisms. If that fails then
you move on to an independent review panel
convened by the health authority. An IRP can
call you to appear before it to enable its members to discover the facts and make recommendations about what to do. And did you
think that's the end of it? Then think again. If
the health authority doesn't like the IRP's
report then it can convene a disciplinary committee, and everything is gone through
again - this time with the health authority acting as public prosecutor and with warnings
and fines promised for those who are found
to be "in breach of their terms of service" (the
general practitioner's contract with the NHS).
Even then the terror is not over, as the case
may then be referred to the General Medical
Council, which might well subject the poor
doctor to an even more rigorous hearing. No
wonder that at least one general practitioner
decided to take his own life rather than face
up to the coming ordeal.
Every doctor must accept the fact that
sooner or later he or she is likely to have to
meet with this kind of experience; it simply
goes with the territory. All one can do is try
to reduce those occasions to a minimum and,
when they do occur, face them in a
stoical and sensible manner.
How do you minimise your
chances of finding yourself in
the dock? Well the obvious
way is by being a perfect
doctor, but there is no such
thing as perfection. Nor is
perfection expected - an
incorrect diagnosis reasonably arrived at is a
good defence, but that
still doesn't stop a complaint being made.
Three things do stop
complaints: courtesy,
concern, and, lastly,
coming in only a poor
third, competence. The
stories of bereaved relatives extolling the virtues
of their general practioner with the words "he's
such a wonderful doctor,
he even found time to
come the funeral" are not
entirely apocryphal.
So when, and not if, a
complaint gets made how do
you minimise its impact? Since
the first stage in the complaints
procedure is usually an in-house
event, either in a hospital or a general practice
surgery, many complaints can be resolved at
that stage if they are handled sensibly. An hour
spent sympathetically, honestly, and, if necessary, apologetically, explaining the issue properly to an aggrieved patient can save days,
weeks, and even years of letter writing, meetings, and their accompanying stress and worry.
And if it does go the distance? Well even
then don't be unduly alarmed. Thousands of
doctors have been there before you and have
emerged a little older, a little wiser, and mostly unscathed. There are lots of people to give
advice and practical help: professional colleagues will offer support, officers of those
bodies running the proceedings will usually
be pleased to explain what is going to happen, and the professional defence bodies will
also provide an experienced doctor or lawyer
to assist and, if allowed, to represent you.
I have seen doctors literally trembling with
fear, I have seen them weep with distress and
shout with anger and self righteous belligerence, but I've never been convinced that it
made much difference to the outcome. The
panels investigating complaints consist of lay
people and doctors who have considerable
experience of sifting out the pertinent facts in
each case; they are unlikely to be swayed by
mere presentation.
Inevitably, however, not all cases are clear
cut, and panel members are only human.
Being dignified, compassionate, and contrite
if necessary and having all your facts carefully
marshalled cannot do you any harm, and a
hot-tempered denial is unlikely to do you
much good, especially in a case that hinges
on one person's word against another.
I recall a case where a doctor had examined a young woman with chest pains and
found nothing wrong. An hour later she was
dead. It wasn't, however, the forcefulness of
the doctor's defence that won the day but the
facts: he had very carefully examined the
woman not once but twice and, sadly, there
simply were no signs of an imminent cardiac
arrest that might have been found.
Try not to worry too much and remember
that things could be much worse - according
to King Hammurabi of Babylon's (1728-1686BC) legal code a doctor who caused a
death could have his fingers cut off!
Steve Ainsworth, writer and IRP lay member, Brighouse, West Yorkshire
Email: LizAins@aol.com
studentBMJ 2000;08:259-302 August ISSN 0966-6494
