In a survey of MPS members who had experienced patient safety incidents in their practice, almost all of them found that it shook their confidence and eroded their job satisfaction
There are three things that should happen following a patient safety incident, regardless of whether or not a complaint is made.
- The most important of these is to take all necessary steps to minimise any harm to the patient and provide prompt advice and/or treatment where appropriate.
- The patient (or in the case of a young child, his parents) should be offered a full explanation and apology.
- Finally, steps should be taken to investigate what went wrong and identify and put in place any measures deemed necessary to minimise the possibility of a recurrence. Information about the investigation and its outcome should be communicated to the patient.
Even though we all know that to err is human, few of us can easily accept our own mistakes. This is probably more the case in medicine than in most other occupations, because errors can have such serious consequences.
In a survey of MPS members who had experienced patient safety incidents in their practice, almost all of them found that it shook their confidence and eroded their job satisfaction.
Complaints from patients tended to be taken as personal attacks, with the doctor feeling angry, hurt and betrayed. Some of these effects lasted for years.
The intensity and duration of the emotional aftermath does not seem to relate closely to the seriousness of the error or the nature of the complaint; the crucial factor is the ability of the individual doctor to put the experience into perspective and seek out practical and emotional support. Lessons can be drawn from this, as listed in Box 18.
If a patient has complained about you, try not to react defensively by avoiding the issue or making counter-threats
If a patient has complained about you, try not to react defensively by avoiding the issue or making counter-threats. Good complaints handling should be carried out in accordance with existing regulations, including the 2009 guidance in England: The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009.
Hospitals have complaints policies that set out the requirements for dealing with and investigating complaints, however trivial they appear to be. It is, therefore, important to let the complaints manager know that a patient has complained about care provided. The complaint should be acknowledged and, at the same time, a plan should be agreed with the patient about how to respond. If there are any delays, an apology and an explanation should be provided to the patient.
To aid the investigation, and depending on the nature of the complaint, you should give a full and frank account of events. Some complaints are minor and it may be possible for you to resolve it satisfactorily by dealing with the patient personally.
It is important to document in the clinical record any discussions that you may have had with the patient, and to seek advice if the matter turns out to be more complex
It is important to document in the clinical record any discussions that you may have had with the patient, and to seek advice if the matter turns out to be more complex than you had thought. The complaint may have arisen from a misunderstanding – in which case, a clear explanation will usually put things straight, resolving the situation immediately.
Some complaints, on the other hand, can be complex, serious in nature and involve a number of health personnel. Do not attempt to deal with these on your own – the complaints manager will be experienced in dealing with these matters. You might only be required to provide an account of your involvement in the care of the patient and the complaints department will deal with the rest, which can include meeting with the patient or the patient’s representatives. If you need it, MPS can always provide advice in these types of situations – help with writing a report, for example.
Many patients who end up taking doctors to the civil courts for compensation say that they have been driven to it because the apology they wanted was not forthcoming. Whether this is true is a matter of conjecture, but in our experience complainants are more often than not satisfied with an apology, accompanied by a full explanation of what went wrong and an assurance that the mistake won’t be repeated.
When something goes wrong for a patient it is essential that they receive an open and honest explanation of what happened and why. They need to know what will be done to put things right. A sincere apology should be forthcoming and incidents investigated to ensure, wherever possible, there is no recurrence.
When something goes wrong for a patient it is essential that they receive an open and honest explanation of what happened and why
Your trust will almost certainly have a “Being Open” policy that should be applied in cases where avoidable harm has befallen a patient. It will include guidelines about what sort of incidents should be reported to patients (whether they should be told about so-called “near misses” where no harm resulted, for example) and who should be responsible for explaining it all to the patient. This will probably be a senior member of the clinical team, but if the job does fall to you we recommend that you talk to a medicolegal adviser at MPS first. MPS advocates open disclosure and a full and sincere apology to patients when mistakes have been made, but such discussions must be carried out sensitively and without criticising colleagues.
Patients expect a great deal from their doctors, not least of which are super human abilities. This means that you are almost certain to disappoint some of your patients some of the time. All you can hope to do in the circumstances is to try and keep a sense of proportion; no doctor is infallible.
Remember, too, that you can always telephone MPS for sympathetic advice and support.