Complaints and COVID-19

04 June 2021

Dr Emma Davies and Dr Rachel Birch, Medicolegal Consultants at Medical Protection, looks at how the COVID-19 pandemic has driven an increase in patient complaints

Complaints are not only time consuming to handle but they also have an impact on our morale. In these challenging times, when healthcare professionals are already under considerable strain, it can feel like the last straw when a complaint is received around the care of a patient during the COVID-19 pandemic. 

There is a sense that the initial outpouring of gratitude and respect from the public has dwindled; most of us are fatigued and frustrated by COVID-19 and so are the general public. It is possible that this is being borne out in some of the complaint cases we are seeing at Medical Protection. 

Practice staff are triaging patients by telephone and consulting with many by telephone or video. But with the ‘new’ way of working through remote consulting comes an increased risk of misunderstanding, unmet expectations and dissatisfaction with the care that is offered or provided, which may result in a complaint.

When working with any limitation of resources, under increased pressure and being hindered by a lack of face-to-face contact with the patient, how can we communicate in ways that reassure our patients that we still want to provide high quality patient care – while also conveying to patients and their relatives what is and isn't realistic?

In this article we will look at some of the common themes that are emerging in our complaint cases and provide examples of some scenarios we have encountered.

The statistics

On average over the last few years, our case handlers have assisted 150 GP members per year in Ireland with complaint cases either directly to the practice or to the Medical Council. In 2020 we assisted 95 GP members with complaints, so there was a significant decrease. In particular there was a decrease in the number of complaints in the months of March through to October 2020. However, in the first ten weeks of 2021, we had already seen 30 GP complaints, and it appears that we are now seeing the usual number of complaint cases coming in. 

What is driving the complaints?

Some complainants have described a sense of doctors using COVID-19 as an “excuse” for saving money by reducing or closing services – these comments have been made in particular where home visits or face-to-face appointments have not been offered. There have been frustrations that after the first lockdown when the country started to open up again, some patients still believed they were  unable to see a GP. These perceptions by the public demonstrate a misunderstanding on their part, and it must feel extremely unfair when doctors become the target for the public’s frustration around regulations and guidance that have not been of their making. 

Common themes and the possible solutions

Difficulty getting access to services: Looking at things from a patient’s perspective, having to listen to a long pre-recorded message around the changes to the practice because of COVID-19 may set a negative tone and increase the risk of patients becoming frustrated. It may therefore be worth revising the practice’s outgoing recorded message to set the tone of the patient journey. Keeping it short and explaining what the practice can do, rather than what they can’t do, may help. 

It may help to look at alternative routes of access to care; an example being the use of e-consultation platforms.

Not offering face-to-face appointments or signposting to hospital: At the beginning of the pandemic some patients may have been misled to believe, for example by the media or talking to other patients, that there was no opportunity for face-to-face consultations. This was despite the guidance that face-to-face consultations could be provided if clinically indicated, or at the very least patients could be signposted to alternative clinical provisions such as the Emergency Department, if appropriate. 

Remote consultations have been a steep learning curve for some where other practices may have been doing triage calls prior to the pandemic. Remote consulting is a skill and as doctors we need to make sure we are asking the right questions and not making assumptions. Safety netting and signposting is more crucial than ever to help avoid patients feeling abandoned. 

The Medical Council has issued helpful guidance1 on the use of telemedicine, which can aid decision making when assessing if a face-to-face appointment should be considered. Medical Protection has also recorded a webinar2 on remote consulting during the COVID-19 pandemic, as well as a specific podcast3 addressing remote consultations in primary care. 

Assuming it is COVID-19 when it isn’t (COVID-19 blindness):
Keeping an open mind is even more important during remote consultations: “Not all that coughs is COVID-19.” We need to make sure we are not pigeonholing patients into a diagnosis without considering the alternatives; again, this is about us asking the right questions during the consultations.

Delay in cancer diagnosis: this has always been a common complaint theme. But the restriction of remote consultations and the perception that cancer services were not running at all (as opposed to a reduced or changed service) led to many complaints.

Grief and displaced anger: Talking with medical colleagues in Ireland,  it has become apparent that the impact of social distancing and not being able to be with or see loved ones when they were ill has led to an increased likelihood of complaints towards healthcare providers. Much of the anger is borne out of a sense of needing to ‘fill in the gaps’ about what happened and a sense of loss and guilt that they could not be there. Empathising with bereaved relatives and understanding how difficult this must be for them has helped reduce complaints. 

Putting complaints into context

The Medical Council has published specific guidance4 for doctors during the COVID-19 pandemic. It acknowledges that this is a very challenging time for doctors, with the health system coming under unprecedented pressure. It provides reassurance to doctors that it will take into account the fact that doctors will have to make temporary changes to their normal practice and be flexible in the ways that they work. It goes on to state that any complaint about a doctor would be considered on not only the specific facts of the case, but also the particular situation in which the doctor is working during the pandemic. 

Within this guidance, the Medical Council specifically reminds patients that doctors will be working incredibly hard to deliver appropriate care to their patients, but that they will be under considerable pressure, and the impact of COVID-19 means they need to deliver care in different ways. It reminds patients that it is helpful if they are understanding of the pressures on healthcare staff during the pandemic.