Navigating complaints with resilience and compassion

Dr Victoria Cox and Dr Sara Jamieson, both Medicolegal Consultants at Medical Protection, explore how to handle patient complaints and offer details of upcoming webinars to support you.

Receiving a complaint is something that no healthcare professional looks forward to, yet over the course of a medical career, it’s almost inevitable. In 2023/24, Medical Protection assisted members in Hong Kong with over 260 complaints.

For many doctors, receiving a complaint from a patient regarding their clinical care, manner or conduct is a distressing and anxious time and may leave them feeling disappointed and disillusioned, especially if they felt the interaction was positive. Receiving criticism can also be frustrating, as doctors are doing the best they can within the restraints of time and manpower. 

There may be a concern that the matter will escalate – perhaps to a claim or a referral to the regulator or even a criminal case. So how do you reduce the stress associated with receiving a complaint?

Complaints can quickly snowball to place a significant burden on the clinician’s shoulders. Often additional stress is exacerbated by tight deadlines to respond to the complainant before properly reviewing and addressing the key concerns. All complaints should be acknowledged quickly. The complainant should be informed that their concerns are being investigated, and a timeframe offered as to when they can expect a response. This should not be so tight that a doctor is under undue pressure to respond before fully reviewing the complaint, but also not so far in the future that the complainant feels their concerns are not being addressed. 

Many clinicians will never have written a complaint response before, and it can be overwhelming to know where to start. An early request for assistance from your medical indemnifier can make all the difference, both in formulating a response and for general support. Several drafts may be required before the response is ready to be shared with the complainant, so early contact will allow sufficient time and help to alleviate some of the stress. 

The aim of a good complaint response is to de-escalate the complainant’s concerns and prevent an onward referral to the Medical Council of Hong Kong (MCHK) or escalation into a claim for compensation. A conciliatory tone should be adopted when responding to a complaint even if it is felt to be unjustified. There is often a reluctance to offer an apology, however the Apology Ordinance1 in Hong Kong prevents an apology being accepted as an admission of fault or liability. If there are any concerns about this, then specific medicolegal advice can be sought. 

Case study

A complaint case from the Medical Protection files, shows how a carefully considered response can de-escalate a situation effectively.

Dr X, a family physician, saw a 58-year-old female patient who was concerned regarding a skin lesion on her left arm that that had changed colour. Despite colleague sickness and an over-running morning clinic Dr X took a history, examined the patient and spent time reassuring her that the lesion was benign. 

Subsequently the patient sought a second opinion from a dermatologist and was diagnosed with a malignant melanoma resulting in the patient undergoing extensive surgery. The patient wrote to Dr X’s clinic to express their disappointment with Dr X’s attitude on the day, explaining that she felt rushed and that Dr X did not examine the lesion properly. Consequently, the patient felt that the delay in diagnosis had resulted in more extensive surgery and this had resulted in significant anxiety and stress. 

Dr X had never received a complaint before and, despite being under extreme pressure on the day in question, felt that the consultation had gone well and was disappointed to learn of the outcome of the patient. He was also extremely concerned to learn that the complainant had threatened to refer him to the MCHK.

Dr X contacted Medical Protection and sought assistance to draft a complaint response. The medicolegal team advised adopting a more objective and neutral tone, explaining in lay terms the examination conducted and the clinical decision-making process. He also expressed his regret that the patient had received such a diagnosis requiring surgery and that she had felt rushed in the appointment. 

Dr X offered to meet with the patient in person to go through the complaint response and following the meeting the patient agreed that their concerns had been satisfactorily answered. More reassuringly the doctor patient relationship was maintained, Dr X continued to assist the patient with her recovery, and no complaint was made to the MCHK.

Summary

Complaints can come out of the blue or sometimes be expected when engagement with a patient’s care doesn’t go as expected. Nevertheless, they can be stressful and add to the burden of the day-to-day job. To assist with managing the stress and anxiety that comes with answering a complaint:

• Set a realistic timeframe to respond to the complainant, and ensure that you follow the local internal complaints handling process, and liaise with the Patient Relations Office as appropriate 

• Contact your medical indemnifier early so they can assist you with drafting a complaint response and advise you how to navigate the situation.

• Read the complaint thoroughly and spend time picking up the key areas of concern and address them in your response. This will demonstrate to the complainant you have properly read and understood their concerns.

• Be apologetic and acknowledge any distress that may have been caused, even if you feel the complaint itself is not justified. Doing so may avoid an escalation of the complaint if you have demonstrated insight and empathy.

• If possible, offer to meet with the complainant face to face. While this may feel awkward many patients appreciate the offer from a clinician to set aside time specifically to discuss their concerns and many complaints can be de-escalated with this approach. 

While stressful at the time, when handled well complaints can lead to better doctor patient relationships, improved clinical systems and more insightful clinicians. 

Continued learning

Members can rewatch the three webinars hosted with Wild Monday here.