I wish to make a complaint - a personal reflection

Complaints in healthcare are serious business. Not only are patients and families increasingly likely to complain, the avenues for expressing dissatisfaction are more accessible and the consequences potentially greater. However, the impact of complaints can be mitigated, and reframed as a beneficial opportunity for all concerned.

I recall one of my first complaints quite vividly. Naively empowered by all the knowledge and wisdom of a medical degree and one year as an intern, I felt omnipotent as I was unleashed upon a small rural community as an unsupervised hospital doctor. The patient repeatedly presented with medically unexplainable symptoms. As we both became increasingly frustrated for different reasons, the patient became aggressive and complained, accusing me of a lack of caring, and then a lack of competence. I responded in all the wrong ways: I became defensive and entrenched, met hostility with hostility, blamed the patient and attempted to restrict access. The issue escalated to a media campaign, a community outraged and executive intervention. There were no winners.

The second complaint was unexpected. It was several years later; my humility and wisdom had grown with experience, and I was proud of my personal and professional development. The patient presented on a Sunday with an acute on chronic painful knee preventing her from weight-bearing. After a thorough assessment and mutually agreed management plan including an urgent referral, she was discharged, and everyone seemed happy. Almost a year later I received a formal complaint indicating that I failed to diagnose her properly, and she had subsequently developed a chronic pain syndrome. Her complaint had apparently been informed and encouraged by her specialist.

I did not become defensive, I became introspective. I reviewed the record numerous times. What did I miss? What should I have done? What could I have done? If an orthopaedic surgeon said I stuffed up, maybe I am not as competent as I thought? What sort of a doctor am I if I can’t manage a simple, painful knee?

I discussed it with colleagues, but then rejected their validation as collegiate and insincere, and assumed they were muttering behind my back. A simple complaint became an assault on my ability and identity, and I took it very personally. I lost sleep and confidence. My practice became more cautious, and I became paranoid.

My response to the first complaint escalated unnecessarily and could have been managed with better communication and greater empathy and humility, exploring the real reasons for the behaviour while acknowledging my own limitations. The complaint was expressed as a personal attack, but it was really a reflection of the patient’s experience.

My response to the second complaint was counterproductive. Reflection and insight are incredibly valuable, but the rumination and self-flagellation are maladaptive. I took the complaint personally, and for a doctor that can be profoundly destructive. I should have analysed it, learnt from it, and moved forward. We are often our own worst critics, even compared to the many people ready to criticise us.

The better experience came several years later.  A middle-aged lady taking clopidogrel sustained a head injury when she fell while roller-skating.  An unremarkable examination, normal CT scan and a few hours of observation without deterioration seemed sufficient for safe discharge into the company of her informed husband.  The subsequent radiologist report received a few hours later, after I had departed, suggested a small subdural.  In my defence, it was visible on only one slice in the coronal plane.  The patient was recalled and admitted for observation, and my colleague notified me. 

I immediately returned to the hospital and discussed the situation with the patient, her husband, and her angry son.  With their permission I discussed it with the neurosurgeon.  I acknowledged the error and their concern, explained what had happened, showed them the images, explained what the ongoing treatment and issues were, and allowed them to ask questions.  I displayed genuine empathy and forgave myself.  The patient and family were very grateful and appreciative of the time I spent with them, and I returned home and slept soundly. 

As Dr Dan Pronk espouses in his book, The Resilience Shield, resilience can develop with post-traumatic growth in response to stress, but can also be improved proactively. Training and education about preventing and managing complaints, developing a support network, and looking after yourself, are critical to longevity in medicine and the inevitable complaints you will receive.

I expect most of us can relate in some way to the experiences I have recounted above. Complaints shouldn’t be feared or seen as annoying, frustrating, or depressing. They should be seen as feedback and an impetus for improvement. We can always do better.

Avant resource

Factsheet: What happens when you need our support

This article has been updated since it was originally published in Connect  magazine issue 21.