Complaints

2. Complaints

3. Reason for Complaints Failure in delay/wrong Diagnosis 30% Attitude or rudeness of doctor 14% Inadequate/inappropriate treatment 11% Other 10% Failure/delay to visit 8% Failure to perform or poor examination 5% Failure/delay/inappropriate 5%

4. Complaints NHS Complaints process Local resolution Healthcare Commission Ombudsman

5. Why do complaints occur? Error Grief Poor understanding/poor explanation Unrealistic expectations Failure to appreciate needs/wishes of patient

6. How to answer complaints Look at the complaint letter, clinical note and response. Consider how you would answer it? What do you think of the response? How could it be improved?

7. Response Aim Resolve concerns Not about who’s right and who’s wrong Factual content Chronology Findings Actions Reasoning Correct Tone Non-confrontational Sympathetic Non-defensive Answer questions raised

8. The complainant is usually far worse off than the doctor

9. Communication

10. GMC - Good Medical Practice 2006 Good Medical Practice (2006) 31 Patients who complain about the care or treatment they have received have a right to expect a prompt, open, constructive and honest response including an explanation and, if appropriate, an apology. You must not allow a patient’s complaint to affect adversely the care or treatment you provide or arrange.

11. Healthcare Commission Complaint Manner in which it was handled Option to undertake Independent review

12. Ombudsman Statement Interview Can compel individuals to attend Recommendations Teeth!

14. Clinical Negligence

15. Clinical Negligence Claims Sued Litigation

16. Why do people sue: to understand the facts for an apology to stop it happening again to get an independent explanation MONEY

17. GP Claims Medical errors 26% Failure to diagnose - surgical 21%appendicitis, torsion of testis, fracture Failure to diagnose - medical 13%meningitis, malaria, diabetes Management of pregnancy & 13%labour

18. Civil Negligence Duty of care Breach of duty Causation

19. Breach of duty Bolam test Guidelines and protocols

20. Bolam vs Friern Hospital Management Committee[1957] “A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art …a doctor is not negligent if he is acting in accordance with such a practice, merely because there is a body of opinion taking a contrary view.” McNair, J

21. Breach of duty- Bolitho Bolitho vs City and Hackney Health Authority[1997] “If in a rare case it can be demonstrated that the professional opinion is not capable of withstanding logical analysis, the judge is entitled to hold that the body of opinion is not reasonable or responsible”

22. Causation Barnett v Chelsea and Kensington Hospital (1969) Chester v Afshar (2004)

23. How to avoid trouble

24. Areas for Good Practice Communication Prescribing Medical records Training Equipment Guidelines/Professional responsibilities

25. Communication

26. Communication Skills Most complainants and claimants mention communication as a problem Most health professionals think they communicate effectively

27. Communication Skills “Before explanation and advice can be given to a patient, three diagnoses must be made - the diagnosis of the disease, the concept or fears of the disease in the mind of the patient, and of the patient’s capacity to understand the explanation.” C M FletcherCommunication in Medicine

28. Communication More than 50% of 263 patients who sued their doctor claimed that they were so turned off by the doctor that they wanted to sue him/her before the alleged event occurred. Mangels Med Econ 1991

29. Communication “He was a cocky b… When my “hypochondria’’ turned out to be a pituitary problem, I couldn’t wait to haul him into court”