Episode 87: Complaints and How to Survive Them Episode 5: What Should I do When I Think a Complaint is Unfair? And Other Questions with Drs Sarah Coope, George Wright, Samantha White, and Andrew Tressider
Whether you’re a veteran with decades of experience or just starting in your career, you always want to do your best for your patients. However, there are also times when you’ve done your best and still you receive complaints. In these instances, you may find yourself growing defensive, your emotions running high.
While these reactions are normal human responses, they can sometimes add fuel to the fire instead of de-escalating the situation. Out of hundreds of happy clients, you will always have a few unsatisfied patients. So, what do you do instead? How do you handle complaints – especially when they seem unfair, unfounded or just plain malicious?
In this episode, we’re joined by a panel of expert guests to share their thoughts on how to handle complaints. Together, we discuss ways that you can adjust your perspective and respond to unfavourable situations. Most importantly, we tackle issues regarding malicious complaints and how to cope with them.
So, if you’re having trouble managing yourself during complaints, then this episode is for you.
Here are three reasons why you should listen to the full episode:
Understand how emotions and behaviour affect how you handle complaints.
- Find out how to have constructive conversations with trainees or colleagues who receive a complaint.
- Discover how you can deal with complaints that are not fair.
[07:07] How to Respond When Someone Wishes to Make a Complaint
- How you initially react determines how the complaint may go. Listen and acknowledge the complaint and thank the patients for the feedback.
- Some people fear making things worse, so they won’t say anything. Unfortunately, silence is the worst thing you can give.
- Don’t worry too much about your response. See what comes naturally.
- Some patients may only be looking for an apology or acknowledgement.
- Complaints are not about facts but rather about feelings when things aren’t going as expected. Working through these feelings is helpful.
[12:59] Should You Display Your Complaints Policy?
- Displaying your complaints policies can reassure people that they are being listened to.
- It also makes the complaints easier to address and avoid inappropriate escalation.
[15:50] How to Handle Complaints When They’re Unfair
- If you want to guide your patient through a behavioural change, you need to build rapport first. A connection and the conversation follows soon after.
- Let the facts speak for themselves and avoid being defensive. Make sure your tone and body language are warm and friendly.
- Keep your language neutral. You can write down an outline of your explanation before facing your patient.
- Showing empathy can make patients feel safe and heard.
[19:51] Learning to Not be Defensive
- Hearing the whole story from the patient’s view is essential.
- You may encounter patients or their relatives who will go through several ‘what if’ and ‘if only’ scenarios. Understand that these thoughts come from a place of heightened emotions.
- During this time, you need to manage your feelings and thoughts. Try examining where your patient is coming from.
- It takes time for extreme emotions to settle, so it’s best to listen first. Tune in to the episode to learn about the snow globe analogy.
- Remember the five A’s: Acknowledge, Apologise, Ask, Answer, and Act.
[26:59] Calming Down During Intense Situations
- During tense situations, plant your feet flat on the ground, make the spine comfortable, and take slow, even breaths.
- As you get back to a state of calm, you are more open to understanding your patient’s complaints.
[29:49] How to Handle Malicious Complaints
- Malicious complaints are rare. It helps to remember to adjust your perspective for these complaints.
- Take some time to calm down. This way, you can come back to things when everyone else is no longer too shaken up.
- You can vent and share your burden with your friends or family. Just make sure to maintain confidentiality.
- Ask what the client or patient really wants to accomplish with their complaint. Luckily, George believes the regulators do recognise malicious complaints.
[35:36] The Five Agreements from Toltec Wisdom
- Be impeccable with your words.
- Take nothing personally.
- Make no assumptions.
- Always do your best.
- Be sceptical but willing to listen.
[37:40] How to Depersonalise Problems
- It’s helpful to have someone support you and identify the source of your complaint.
- A lawyer can also get in between the doctor and the complainant. You can also go directly to the regulator.
- Set a boundary between your work and personal lives. Malicious complaints can seep into your personal life if you’re not careful.
- The aim is to resolve complaints, not to win the situation. Your patient’s satisfaction is what matters.
[44:49] The Emotional Occupational Hazard of Being a Healthcare Professional
- Being a health professional usually involves the task of absorbing emotions and complaints from patients and their relatives.
- Time can play a significant role in dealing with complaints. Focus on keeping calm, and eventually, you’ll see the big picture.
- Be kind to yourself. Instead of sulking, see your mistakes as an opportunity to grow.
- You may not find a resolution for problems, and that’s just the way it is.
- Having facilitated meetings with the patient is useful. The show of emotions can help complainants and doctors understand each other better.
[50:18] How to Handle Complaints During the Pandemic
- You have to deal with COVID-19 complaints the way you deal with other complaints.
- But don’t be afraid to be straightforward, especially if the complaints are on things you can’t control.
- Discuss how you, as a team, can efficiently and consistently handle pandemic-related complaints.
- Pinpoint a person in your team who is good at de-escalating.
- Understand that there are different levels and kinds of loss during the pandemic. The amount and varied kinds of loss can affect the volume and nature of complaints.
[59:47] Supervising Trainees Dealing with Their First Complaints
- Reassure and support your trainees. Let them know their reaction is normal and walk them through the usual complaints process.
- Think about what you would’ve needed as a trainee back then. Create a safe, supportive space for the trainees.
- As a supervisor, make sure to give time and support to your colleagues. Remember that most healthcare professionals suffer imposter syndrome too.
- You should be in the right time and space when talking to complainants.
- Share the complaints you have had in your career as well. Through this, the trainees can learn and grow from your experiences.
[1:07:13] Parting Advice for How to Handle Complaints
- George: Don’t bury your head in the sand. Let your colleagues help you as you would for them.
- Andrew: Stay calm.
- Sarah: Ask yourself what’s happening behind the complainant’s mind.
- Sam: Know that you will get through it.
Powerful Quotes from This Episode
[07:38] ‘The first thing to do is to take it seriously, to really listen to the patient, to acknowledge that they have, something’s happened that they’re unhappy about. And hear what it is.’
[08:51] ‘Complaints, unfortunately, are a fact of life. And we all have processes and policies in place to deal with these things.’
[13:12] ‘I think the easier you can make it through a patient’s complaint, the more likely you are to resolve that complaint early.’
[18:56] ‘I think it’s so important to build that connection with patients before going into any sort of explanation yourself. But also the way that you talk to them: if you’re conveying sincerity, if you’re conveying empathy through your tone, through your non-verbals. That really demonstrates to the patient that you’re taking them seriously.’
[56:42] ‘Having that team approach is so helpful because it does take its toll on the team if there’s lots of complaints coming through.’
[58:36] ‘We always need a professional response because there’s a person behind it. But we also have to have the understanding this is what society is going through at the moment, these times of pandemic and people adjusting to change and loss.’
[1:08:42] ‘It can feel at the beginning of the process that can feel like this huge mountain, but you will get through it. And the overwhelming majority of doctors and dentists I’m sure, go on to have a very successful career, and to look at it from that wider perspective of life.’
Dr Sarah Coope now works full time at Medical Protection as a medical educator delivering risk prevention events for doctors and dentists. Her background is in UK general practice, having worked as a GP partner and then a portfolio GP. She’s an experienced communication skills trainer and coach. Before joining the MPS, she was involved in local coaching and mentoring for doctors who had had complaints or were facing disciplinary action to help facilitate positive change in their communication and consultation skills. You can reach her through her website and Twitter.
Dr George Wright is a dental surgeon who also works as a senior dental educator and dentolegal consultant at MPS Dental. He has a reputation for being caring and compassionate with both anxious patients and also with dentist trainees. Outside of work, Dr Wright spends time with his three children and their Border Collie. You can connect with him through his website and Twitter.
Dr Samantha King is a vocationally registered GP and medicolegal consultant with MPS New Zealand. She helps doctors through the complaints processes all the time and understands how it can impact them. Dr King considers it a privilege to be able to assist her colleagues in this way. She has three adult children and enjoys being on the water and fishing. You can connect with her through her email.
Dr Andrew Tressider is a Somerset GP and MRCGP. He is as equally concerned with the health of health professionals as he does with patients. With this particular interest, he founded the Somerset Clinician Support Service. He also teaches medical professionals the importance of health and self-care. You can find out more about his work through his website and email.
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Dr Rachel Morris: Do you live in fear of a complaint? Do you dread making mistakes or getting something wrong? No one goes to work expecting to fail and no one ever likes to be wrong or receive a complaint. But making mistakes is normal. After all, no one has a 100% success rate, and receiving complaints from patients and clients could be seen to be an occupational hazard. We know this. So why do we find it so hard to cope when it happens? And it will. That’s why we’ve put together a series of You Are Not A Frog podcasts on complaints and how to survive them.
Going through a complaint or investigation is one of the most stressful things that can happen in your career. And I’ve seen firsthand the anxiety and emotional turmoil it can cause. and I know what it’s like to berate myself when I inevitably fail. But it’s because we care that we find these aspects of our professional practice so difficult. But what if there’s a better way of handling things? What if we could learn to view the whole complaints process as just another part of our professional practice, and learn the skills we need to manage ourselves, our colleagues and our patients in an empathetic and compassionate way throughout?
In this episode, we’ve got a panel of experts in to answer some of your questions. We talk about what to do if you suspect that a patient just has it in for you and is making a malicious complaint, how to recognize what’s actually going on for them, so that you can avoid those defensive and angry responses to complaints that just don’t seem fair. We also talk about how you can cope as a team with the extra complaints that have come in as a result of the pandemic, and the associated fallout, as well as discussing about how to have a constructive conversation and support a trainee or colleague who has received a complaint. So listen, if you want to understand how complaints often about emotions, rather than facts. Listen, if you want to learn how to deal with complaints that aren’t fair, and find out how you can best approach conversations between trainees and supervisors, when a trainee receives their first complaints.
Welcome to You are Not a Frog, life hacks for doctors and other busy professionals who want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP turned coach, speaker and specialist in teaching resilience, and I’m interested in how we can wake up and be excited about going to work no matter what.
I’ve had 20 years of experience working in the NHS and I know what it’s like to feel overwhelmed, worried about making a mistake, and one crisis away from not coping. Even before the coronavirus crisis, we were facing unprecedented levels of burnout. We have been described as frogs in a pan of slowly boiling water, working harder and longer, and the heat has been turned up so slowly that we hardly noticed the extra-long days becoming the norm, and have got used to the low-grade feelings of stress and exhaustion.
Let’s face it, frogs generally only have two options: stay in the pan and be boiled alive, or jump out of the pan and leave. But you are not a frog. And that’s where this podcast comes in. You have many more options than you think you do. It is possible to be master of your destiny and to craft your work and life so that you can thrive even in the most difficult of circumstances. And if you’re happier at work, you will simply do a better job. In this podcast, I’ll be inviting you inside the minds of friends, colleagues, and experts, all who have an interesting take on this. So that together, we can take back control and thrive, not just survive in our work and our lives and love what we do again.
Did you know that for every episode of You Are Not a Frog, we produce a CPD worksheet, which you can use to reflect on what you’ve learned and claim additional CPD hours. And if you’re a doctor and you want even more resources about how to thrive at work, and to join our Permission to Thrive CPD membership, giving you webinars and CPD coaching workbooks, which will help transform your working life. Liinks are in the show notes.
Now before we dive into this episode, I’d like to share a word from our partners from this series on complaints. It’s all too easy to feel overwhelmed. And for many healthcare professionals, it’s not only feelings of burnout and stress which can be challenging, there’s also the nagging worry of making a mistake and a patient claim being made against you. It’s enough to give you restless nights and impact your day to day, but you don’t have to go it alone.
If you’re a member of medical protection or dental protection, you can access a range of support from clinical professionals who understand what you face, who are here to help you in not just the legal stuff, but your emotional and mental well being too. From expert medical and dental legal teams to independent counselling through webinars and on demand content, you can access it all as part of your membership so you can focus on loving your job, not fretting about it. Find out more about www.medicalprotection.org and www.dentalprotection.org. And now here’s the episode.
So welcome to the final episode in our series on complaints and how to survive them. This is a very special episode. This is a question and answer session. So we don’t know exactly what we’re going to be talking about, but I have our panel of expert guests with me. So welcome, everybody. Thank you so much for being here. Let me just introduce you all. So firstly, we have an old friend, Dr. Sarah Coope, she’s a GP by background. She’s a senior medical educator at Medical Protection, and you’ll probably recognize her from Episode One of this series. So welcome, Sarah.
Dr Sarah Coope: Thanks very much, Rachel. Nice to be back. Thank you.
Dr Rachel: We’ve also got George Wright. Now, George is a dentist and a dentolegal consultant, and a senior dental educator at Dental Protection. So really good to have you with us, George.
Dr George Wright: Good morning. Thank you, Rachel. Thanks for having me.
Dr Rachel: Morning. And we also have I’m all the way from New Zealand, Dr Samantha King. She’s a practicing GP. She’s also a medicolegal consultant and educator at NPS, New Zealand. So Sam, thank you so much for joining us today.
Dr Samantha King: Oh, it’s great to be here. Thank you.
Dr Rachel: Last, but definitely not least, we have Dr Andrew Tresidder and Andrew is at Somerset’s CCG clinical lead for medicines management and pastoral care. He’s a GP and a GP appraiser and works also for NHS Practitioner Health, where he’s the clinical lead for the southwest region, amongst lots of other things. So welcome, Andrew.
Dr Andrew Tressider: Thanks very much, Rachel. Great to join y’all.
Dr Rachel: So we got a list of questions, sort of commonly asked questions, people, questions that people have been asking us throughout the complaint series. I’d like to start off and kick off with this one, and I think this is a really, really common question and common thing that everyone has worried about at some point or another: what should I say to a patient or a client, when they wish to make a complaint? I’m worried that it could make the situation worse. How do you respond in that moment when someone tells you they wish to make a complaint? Firstly, Sarah, can I ask you that?
Dr Sarah: Yeah, I think it’s a really good question, isn’t it, because how we respond in that first moment can probably shape how the complaint then develops, I suppose. So there’s a real opportunity in that first moment to I suppose nip it in the bud in some ways, and smooth things over with that conversation with the patient, or actually respond in an unconstructive way or destructive way that actually can lead to it escalating.
So I think that I’m interested to know what George says, from a dental perspective, as well. But I think in medicine, the first thing to do is to take it seriously, to really listen to the patient, to acknowledge that they have something, something’s happened that they’re unhappy about, and hear what it is and hear it out before then making any kind of response in terms of of your explanation for things.
I think patients will take it further if they feel they haven’t been listened to, if they feel that there’s been excuses made, if they feel that their feelings aren’t acknowledged. So I think that’s the first thing that we need to do, is we listen to it, and actually thank them for the feedback, thank them for the opportunity to respond to it that we can learn from from that. And that’s my first initial thing is more I could say, but George experiences know from a dental perspective, what your thoughts are.
Dr George: Yeah, I agree with everything you said there, Sarah. I think it really is challenging when you are the rabbit in the headlights. I think the first thing I’d say is perhaps don’t focus too much on that worry about making it worse. Sometimes, we overburden ourselves in that way, and that can actually make the situation more challenging. Definitely saying nothing, or that silence is worse than probably anything you could say. And whilst I totally agree with Sarah, that nipping things in the bud is a really good aim to have, don’t be too hard on yourself, if you don’t nip it in the bud.
Complaints, unfortunately, are a fact of life, and we all have processes and policies in place to deal with these things. So if you’re in that position, and you haven’t been able to resolve it, don’t be afraid to signpost the patient to the practice complaints policy or the hospital complaints policy. Reassure them that you have the process in place and you’ll be happy to escalate it in an appropriate way. I suppose the final thing to say for me is see what comes naturally, we’re all caring healthcare professionals, so it’s highly unlikely we’re going to say something really unsympathetic to the patient. So maybe don’t worry too much about what you should be saying because you can find yourself tripping yourself up there.
The classic we have is the we were often contacted by colleagues that worry that saying sorry is going to make the situation worse or or they might be in trouble with their indemnity provider for saying sorry, so that’d be on. I mean, these are myths that we work very hard to burst. Just say what comes naturally to the patient and you’ll probably surprise yourself how quickly you can de-escalate the situation.
Dr Rachel: Is it true that a lot of patients, they are just looking for a bit of an apology and and an acknowledgement? If that has happened, then actually they’re probably less likely to really go off to you. Is that your experience?
Dr George: Yeah, totally. I think we worry too much that patients want someone’s head on the block, and they want someone to blame, whereas actually, if you think about it from whenever you’ve been a patient, often all you want, you’re absolutely right, is an acknowledgment that your, what your concerns or your feelings about the way you’ve been treated have been understood and recognized. Absolutely an apology can go a huge way to de escalating the situation. And very often, that’s the end of it.
Dr Rachel: What do you think, Sam?
Dr Samantha: I think that for GPs, in particular, and I’m assuming for dentists, that because you’ve got this longitudinal relationship, you’ve got a lot of credits in the bank anyway. So if you apologize, the patients are far more likely just to let it go and to feel satisfied. I think that I agree with George that often we’re too scared about what we’re going to say, particularly the sorry.
Dr Rachel: I think my reflection is that if a patient tells you that they’re going to make a complaint, my instinct, and I think a lot of people’s instinct is, okay, what can I say now that’s going to make them not make that complaint. Initially, you become a lot more defensive, and the problem is, when you’re then feeling defensive on the back foot, you can’t quite react in the manner that you would want to. Andrew when you’ve sort of seen this with people, what advice would you give them to try and manage their own emotions right in that moment?
Dr Andrew: Thank you. That’s a really good question. So complaints I see are not about facts, because outcomes can be good or less good outcomes can be adverse, and all practitioners are trying hard. They’re caring, and they’re investing in good outcomes. In a way we’re sort of professionally investing our love in doing our job well. Complaints are not about facts, they’re about feelings. It’s about feelings when things haven’t gone so well. And it might be something very minor, or it might be something very, very major. I think an understanding of how to work through the feelings, both for the patient and for the practitioner, can be quite helpful.
Dr Rachel: Yeah. And I think that whole sort of working through your feelings, you can be like Georgia says rabbit in the headlights sort of just like, oh my goodness, what do I do? I think sort of sometimes taking a pause can be quite helpful, can’t it? And not not responding immediately. But I just wanted to pick up on George’s point about pointing them to the policies and the procedures, and this is the way you can do it, and let me explain it to you. We’ve had another question says, do I need to display my complaints policy? I’m worried it might encourage patients to complain. So if we actually tell them about the complaints process and what the next step is, and what they can do? Will they encourage people or will that just reassure people?
Dr George: I’ll jump in there, if I may, Rachel. I think absolutely reassures them, it may encourage them insofar as it might make the route to make your complaint more straightforward for them. But actually, I think the easier you can make it through a patient’s complaint, the more likely you are to resolve that complaint early. We see in a number of cases where the barriers are put up to making a complaint. And actually, the complaint escalates to the patient complaining about the complaints process, rather than the initial catalyst for the complaint.
If I can just talk from personal experience, very briefly, I received a complaint to our regulators to the general dental council a number of years back, and the patient didn’t complain to the practice, they went straight to the regulator. Now reflecting back on that, what I would do if I had a similar situation tomorrow, is make sure the complaints policy was on a neon piece of paper with red flashing lights around it, because the patient would have seen the first protocols of the practice and they would have been listened to and they’d have gotten the answers that they wanted. Hopefully we could have avoided all that stress of the escalated process. So for that reason, I advocate very strongly for having that policy on display, making sure the staff know about it, and making sure that patients are aware of it if and when they want to complain.
Dr Rachel: That’s a really interesting way of looking at it. I’d never thought of that actually, it can help you avoid inappropriate esque escalation. Andrew, you were gonna say something.
Dr Andrew: I love what George’s phrase being listened to, because the reason that we make a complaint and the reason we want to be taken seriously is because we want to be heard. We want to tell our story. In occasional serious issues, where there are grave consequences and grave financial issues, then maybe we’re out for more than that. But in the, I would guess in the great majority of complaints, we want to be heard. We want an apology. We want to understand that there’s been learning and that’s what matters.
Dr Rachel: So, Andrew, we’ve got the next question, which I think ties in very well with that. So not all complaints are due to clinicians making errors. Often patients don’t want to hear that it was bad luck just happened to them. So they’re angry. And like you said before, it’s about their emotion. It’s about feeling it’s not fair. Why is it happened to me? So how do we deal with that? Because we did have sort of one coming from one of the podcast listeners that how, it’s fair enough dealing with a complaint where there has been a mistake, and something has happened. But if it’s not your fault, and the patient is just cross about something, maybe there’s been a misunderstanding, or maybe they just don’t like what has happened to them. How do we not be defensive? How do we cope with that?
Dr Andrew: Thank you very much, Rachel. It’s a challenge on two levels. I think it requires our clinical skills of working with colleagues and working with patients and people, of managing people. One of the things that all practitioners do is they manage behavioral change. What do I mean by that? If somebody presents to me as a GP and they’re smoking 30 a day, I might just give smoking cessation advice, stop smoking, it would be a good idea. If I just say that as soon as they come into the room, because I smell smoke on them, I think I’ve got about a 0% chance of success and about a 90% chance of a complaint.
We have to go through what’s called the Solihull triangle of, firstly, we have to build rapport, secondly, a connection and a conversation, and then we can move on to behavior management. So we have to always use our professionalism, to stay calm, to build that rapport, to build that connection to make sure there is a dialogue happening. Then we can move to helping guide the person forwards. What are we guiding them through? I think perhaps Sam might like to speak at this point, because we can come back to that.
Dr Sam: Yeah, I always tell our members to let the facts speak for themselves, that you, often I think our natural response is to feel defensive. But if you think about it, if you just give them the facts of what happened, but keep your tone warm, the tone is really important when it comes to responding to people.
I think there’s a big difference with saying “What’s wrong with you?” to “Gosh, what’s wrong with you?” If we keep a warm, friendly tone, and keep our body language reflecting our tone, I think that really helps. I think that the patients really do, I think a number of my colleagues here have seen similar things, the patients want to feel acknowledged and heard, because I think we all do. So first stop, if you come out with acknowledging how they feel, and apologize for what you can. I’m not saying you should apologize for doing something that you didn’t do. It’s about saying, you can even say I’m sorry that this has happened to you.
This helps their emotions to settle. And I think when their emotions settle, they’re better able to listen to the facts in a more reasonable frame of mind. I think it’s quite hard for us to keep our language neutral. Because doctors aren’t used to dealing with these sorts of tense situations. But it is a skill that you can learn, and often the best way I can suggest is, before you meet with a patient, if you can, if you write it out, and get it clear in your head and get your language sorted, it means that when you come to talking with them, it’s easier to keep your tone, your body language warm and friendly, and the words you’re saying will match that. I think that goes a long way to taking the heat out of it for complainants.
Dr Rachel: Sarah?
Dr Sarah: Yeah, I agree with with what Andrew and Simon said, I think it’s so important to build that connection with patients before going into any sort of explanation yourself, but also the way that you talk to them, if you’re conveying sincerity, if you’re conveying empathy, through your tone through your nonverbals, that really demonstrate to the to the patient that you’re taking them seriously. I think when people are unhappy with something, even if it was something that was actually preventable. I think we know from research that 40 to 50% of adverse outcomes were probably not preventable, they occur because of recognized complications of treatments, because of perhaps unforeseen medication reactions. Those things, we couldn’t have predicted them. It isn’t a negligence, it isn’t someone’s mistake, but it still happened to them. therefore their experience isn’t optimal, that something is gone on that actually they are struggling with or they’re suffering as a result. So conveying to that patient that you are sorry, I’m sad that this has happened to them, could go a long way just to build on that human connection.
Dr Andrew: Hearing the whole story from their point of view is so important. Because as as as Lamb says the facts are important, but their connection of how the facts work. And what they have told themselves is so important. I’m just thinking of bereavement visits that I would do as a GP in order to ensure that the new patient, the loved one who has lost their loved one, is able to transit grief effectively, the phases of grief. I would always explain to them the facts, and also then say, and you will meet two families, you will meet the what ifs and the if onlys.
What if we’d stayed in Lancashire rather than moving to Somerset? If only he’d stopped smoking five years ago? What if I’d fed him more vegetables? If only she’d done so and so? And from the absent relative? If only I’d visited more frequently. What if the doctor so and so if only the nurses such and such? What if they’d given this medication instead of that medication? What if they’d taken him to hospital sooner? If only I’d visited more frequently. I would say to people, you will meet the what ifs and if only as part of the grieving process when you meet them, as we meet them every moment of every day, because we are reflective beings, you won’t dismiss them because they’ve got emotion attached. Normally, they just dissipate. But when they have high emotion attached as we’re transiting grief and loss, they can start to circle and cycle and pester and fester, and turn to poison, which we either hold inside as guilt, or we spit out as anger at somebody else. So if you meet either of the what ifs or the if onlys, these families, just tell him to push off.
Dr Rachel: That’s interesting. This whole what if and if any, presumably, under you’re not saying tell the family to push off, it’s nice to push off.
Dr Andrew: Absolutely. Because otherwise, a grieving relative can find themselves plagued for days, weeks and months by faults going round and round and round in their minds. We find it difficult to escape that cycle. It’s not actually the thoughts that’s the root problem. It’s the unresolved pain hurts loss or distress.
Dr Rachel: And that’s really interesting you’re saying that, Andrew, because it’s these thoughts that, isn’t it, that’s causing us distress. I know Sarah and I were talking about the thoughts and the stories that we have in our minds, and I think that’s one of the problems when we’re dealing with complaints. We’re thinking to yourself, it’s not my fault. This is really unfair. How dare you start to insinuate, it’s my fault. And then we project it to the future, oh, my goodness, I can see this complaint running, and I can see it going to the GMC, and blah, blah, and these might all be going around in our head while the patient is just telling us about it.
So how do we avoid that leaking out? Because what I found saying, it’s all about tone and body language. And that’s fair enough. But if you’ve got these thoughts going around your head, they do just leak out. I think we do find it really difficult to have an open conversation without being defensive. What advice would you give people about how not to be defensive, Sarah? Or perhaps how to change the stories and all that sort of thing?
Dr Sarah: Yeah, so in the work, I’ve done, coaching doctors who perhaps had a complaint, before I joined medical protection with work with doctors in difficulty, who has been referred to the GMC, I’m sure Sam and George and Andrew have had similar experiences as well of working with doctors on a one dentist and a one to one, but I think a lot of it is just recognizing the normal sort of automatic response or reaction is to defend ourselves, isn’t it, against a threat. I think often what I would try and help someone to do is to bring that meaning that they’re making out of what’s happened into the light, because as you say, often it’s going on in the back of our minds, often kind of unconsciously, and we’re not really aware of that meaning that we’re making, sort of hadn’t experienced understandably, feel scared about what the implications could be.
But it’s recognizing, actually, what am I telling myself? And how is this helping me? How’s that affecting my feelings, and then that’s affecting my behaviors. And something about just recognizing that pattern. And thinking if I want to be feeling and doing something different, I need to get back to what I’m telling myself. I have a strange analogy that I just like to share with you here. It’s about snow globes. So you already know there’s snow globes that you can shake up and snow falls down and it sort of falls into the scene. I would sometimes use this analogy whether it’s helpful or not, I don’t know, but I’ll share it with you.
So imagine that the other person, that’s the patient, has a snow globe and you have one as well. And when the patient is angry or upset, it’s like that snow globe is shaken up, so that the snow is their feelings. The situation or their position is the scene inside the snow globe. So when they’re upset and angry, they’re shaking up the snow globe, you can’t see really clearly what’s going on them you can’t see the issue. And then if you shake your own snowglobe up you can’t see out you know, it’s like nope, no help at all because you’re both completely and neither can see in, neither can see out. So there’s something about just holding your snow globe to let the snow settle by managing your own sort of feelings.
And that’s often by managing the meaning that you’re making to the situation. So that you can then see out of your snowglobe. Comfort, convey that sincerity, that empathy to the other person so that their snow settles, and then they can, by empathizing and by sort of asking questions to understand what’s going on. Once their emotion is settled, they can see more clearly as to what’s going on for you. There’s something about just managing and holding yourself, which is really tricky, and it takes time to help someone sort of do that. But I guess so that you can see clearly what the situation is for the person before you try and explain your position.
I don’t know whether that’s helpful. I’ve not really explained it. But it is easy with a visual prop, I think. But there’s something about just about recognizing the feelings and how often we respond in kind, we often tend to respond and by matching the other person’s feelings, perhaps rather than trying to hold our own state and manage our state, and that is easier said than done.
Dr Rachel: Yeah, I love that analogy for snow globe. Because we all know that actually, you can’t just say, oh, it’s fine now. It actually takes time for that snow to settle and really like recognizing ourselves, it’s going to take time for the snow to settle for, it’s probably not the time to have a very deep conversation about whose fault it was or what actually happened. Now’s the time just to listen. And for empathy in and wait to look at that, you know, it might take days or weeks for that for the globe to settle properly. Andrew–
Dr Sarah: Sorry, I’m just gonna make assumptions about what’s in the other person’s snowglobe, and we can answer thinking that we know what the problem is and what they need to hear. And we need to ask you, I’ve just got five quick A’s Sorry, I’ve just, acknowledge, apologize and ask questions, before you answer and then act. So I think there’s five A’s that can be really helpful to do it in that order. Often, we come in with our answers first, before we actually even ask the person what is going on, and perhaps what they want to have happen. Yeah, sorry, just to chip in with that.
Dr Rachel: That’s really helpful with the five A’s, we will list those in the show notes for people. Andrew?
Dr Andrew: I’m just picking up on what both Sam and Sarah has said. So Sam said a calm, friendly manner, and Sarah, I love the snowglobe analogy, but just before you mentioned that, you use the word threat. That’s really interesting, because any threat sets off our mammalian body autonomic nervous system. The first thing that happens is that we may get parasympathetic freeze as we go through shock and denial and shock is the first thing that happens. Then we go on to fight and flight. This is not what you and I as health professionals, as highly trained people are doing this is what our mammalian body is doing under the surface, because we feel threatened.
The fight and flight mechanism involves adrenaline, it involves fear, it involves raised blood pressure, pulse going faster, sweaty hands, dry mouth. And so our challenge is to allow ourselves or to take control of ourselves before we can in our own snow globe, before we can help the other person, the patient with their snowglobe.
So one might want to try feet flat on the floor, spine comfortable, and slow down your breathing, nice open posture and just ensure that whatever the bad news you’re hearing, or the difficulties or all the tragic lament that the patient is sharing with you of what has happened, because sometimes some dreadful things may have happened for people in their lives, or they wish to complain. We take control, we calm ourselves right down to slow, regular rhythmic abdominal breaths, and in that situation, we can listen clearly, we have peripheral vision, we hear everything that’s going on, and we understand the emotional nuances of what the patient is trying to say.
Whereas if we’re a bit frightened, we’re worried about ourselves. And then we’re starting to breathe rapidly and chaotically and upper chest which is what we do in sympathetic and our speech starts getting fast and we start being defensive and we start trying to answer the questions. What happens is we’ve missed all the big picture and we miss everything that the patient’s tried to say because they can’t, we can’t hear it. We’ve missed it.
Dr Rachel: Thank you. So really important, just stop, ground ourselves, try and get back out of our sympathetic zones into our human thinking brains. I think a good book that I found helpful about doing this is The Chimp Paradox by Dr Steve Peters, who talks about this reaction, being you’re in a chimp. Now the problem is, there are some patients, I think, or I think many of us think, who are trying to be malicious, or we feel that they’re trying to be malicious. George, do you think that patients do come out as maliciously and make malicious complaints?
Dr George: It certainly happens, but I don’t think it happens anywhere near to the extent that we often think it does. We do see malicious complaints. Or we see complaints where patients have have sinister motives, perhaps, for instance, that they’re after compensation, but they don’t want to come out and say that. I think it’s really important to keep perspective, not just relating to, in relation to malicious complaints or complaints in general. You need to remember that you see hundreds and hundreds of patients, and we’re talking in this podcast in the series about the very vast minority of patients here. For every patient that’s unhappy, you will have hundreds of happy patients.
I think the bottom line for me is that we don’t go to work to experience or suffer abuse from our patients, or the relatives of our patients. So if you do find yourself in the real difficult backed into a corner situation where you are being threatened, and you feel the patient is being abusive, then don’t be afraid to call time and get out of that situation. To go back to Sarah’s snow globe analogy, there can be situations where no amount of time in that moment is going to allow the snow to settle. You’re going to just have to, to leave it for a little bit longer and come back to it when you’re in a better mindset.
But yes, they do make malicious complaints. A good tool for that is, is sharing the complaint with your friends, your family, your colleagues. Now, of course, you need to be mindful of patient confidentiality. But sometimes we take that too far, and we don’t think that we can tell our husbands, our wives, our children about the fact that we’ve had a complaint, or that we are feeling under pressure at work, because we’re dealing with a complaint. You can have all sorts of conversations with with these loved ones without divulging patient confidences.
I think sometimes sharing that burden, particularly when it’s a malicious complaint, because these can go on and on. Sometimes you get to the sixth time that you’ve responded to a patient, and you just have to sometimes get to the point and say, ‘Look, we’re not getting anywhere here.’ And sometimes asking the patient, what do they want, rather than skirting around the subject, just fronting it out. ‘What is it you’re looking for out of this complaint? We’ve answered all your questions. We’ve promised to put in place the systems changes, all the rest of it, what is it now, that is preventing us from drawing a line into your concerns?’ Sometimes that can just help get it over that line?
Dr Rachel: It’s very frustrating though, isn’t it, when patients are either after something or they just got it in for you. And we really worry that other people won’t recognize that that’s the case. Do you think that the regulators can recognize when the complaints are malicious, and do the defense unions really recognize it?
Dr George: Yeah, I think absolutely, you have to remember that, whilst I’ve just said, it’s very rare for for clinicians to have complaints, it is our bread and butter. This is like your patients coming in and asking you about the most common procedure or condition that you might deal with. You very quickly develop that sense of when a patient is pursuing ulterior motives, or they’re being malicious in their approach. I think to be fair to the regulators, I think they do see that, I think it is taken into consideration. All you have to do is share your responses, particularly if you’ve got good records of the conversations that you’ve had, and you’ve kept records of any letters and correspondence.
Any person in the field can take a look at those and say, ‘Well, these are all very reasonable ways of managing the situation, and we’ve now got to the stage where the patient isn’t being isn’t being reasonable.’ So, to your question, Rachel, yes, I think I think it is recognized. But also just to drive that point home, it is very rare, it does happen, and unfortunately, the consequences when it happens can be quite significant. It can really take its toll on someone, it can really overwhelm you and become the, you know, the sole focus of your thoughts in work outside of work. That concept of getting that support around you, when you come across these rare patients is really important.
Dr Rachel: That’s really hard, isn’t it? Is there anything that a doctor or a dentist or guests, anybody who’s in a profession where there’s a sort of very malicious complaint. Is there anything that you can do to sort of protect yourself from that patient? Because we can’t guess what you really want to do is, ‘I’ll sue you back for being mean, and I’ll get you back,’ because you then just, because you feel so helpless, you then start lashing out. What would you suggest Andrew?
Dr Andrew: It took me about 15 years or 20 years in practice to realize that although I wanted to help everyone and wanted to make everyone better because that’s why I went into medicine that actually there may be 1% or 1.5% of patients who not only resisted that, but gave me a hard time. It was a huge relief of that burden when I realized that the same people I understood in the time where I worked actually give people in the bank a hard time, and people in the supermarket a hard time, people at the garage a hard time, and quite possibly their husbands or their wives a hard time.
I think there’s something about recognizing that there are sometimes difficulties. I think having said that, and that’s not to say that, please don’t think that’s to try and trivialize people and stigmatize them. Firstly, anger may actually cover anxiety, we should always remember that. Secondly, I love something from South American wisdom, some Toltec wisdom, which of the five agreements are number one, something that we all do as professionals, be impeccable with your words, say what you mean, mean what you say, don’t say anything else, that’s quite easy.
Number two, take nothing personally. That’s really difficult sometimes, particularly when we’ve invested a lot in our relationship and, and spent a lot of time or effort. Number three, don’t make assumptions, make no assumptions. Of course, we all are guilty of that at times. Number four is easy as a professional. Always do your best. That’s what we do. Number five is interesting. What’s going on behind what’s going on, be skeptical, but learn to listen. So always listen, but ask yourself, what’s what’s actually going on? What am I hearing? But what am I not hearing? What’s the story happening for this person behind what’s going on?
That challenge of being able to look at yourself and reflect in action is really quite a challenge as a professional because we’re busy doing the day job, let alone trying to think about it, and trying to manage our own reactions, but by having some understanding of framework like that it can help.
Dr Rachel: I love that framework. And yes, we’ll get that off you and put that in the show notes. Andrew, thank you. And I think it’s a professional skill that we need to develop, isn’t it this whole depersonalizing things and work out what’s going on behind the thing. I think one of the steps in the interest based relational approach to negotiation by the book Getting to Yes is first of all, separate the person from the problem. You’ve got this person, and there is this issue that this mistake might have been made or that there is this complaint being made. But it just feels so personal, and particularly when you feel there is a perhaps a malicious element to it. I mean, Sam, as a medical legal consultant, how do you advise your clients to deal with it when you suspect there is something malicious going on?
Dr Andrew: It is really difficult. Of course, when people feel that it is vexatious that there’s nothing, no basis to it. Part of my job is to talk to members to give them a perspective, to be able to say, yes, I recognize that this is a vexatious complaint, that when I’ve looked at your clinical notes, I don’t see that you’ve done anything particularly wrong. That provides huge reassurance. Because often, when we get a complaint, it’s hard for us to work that out. Have I done something wrong? Have I really messed it up? Or is it that everything’s fine, and this is just a vexatious complaint? So often, just getting someone to support you and to identify it for you, I think is really helpful.
I think the other thing that we do too, is to if we need to, we would step in with a lawyer. So the lawyer comes between the doctor and the complainant. The other thing we do sometimes is to encourage the complainant to go to the regulator or to go to the Ombudsman. We have an HDC system in New Zealand, but to go to your equivalent of the Ombudsman, and that ombudsman then becomes the intermediary between the vexatious patient and the doctor. We don’t obviously, we don’t encourage that very often. But in a vexatious patient situation, I think that’s actually helpful. I don’t know whether, George, you would do that for your members.
Dr George: Yeah. And the thought that’s just come to my mind there as you were talking, Sam, is also the fact that we take these complaints home with us a lot, and I think as clinicians, we want to bring a conclusion to a complaint as quickly as possible. We think that means making yourself really available to that complainant and I have occasionally helped colleagues where they’ve given the patient their personal mobile number or their personal email address, and then if you pick up one of these malicious complainants, it becomes so embedded within your personal life as well, that the problem just escalates and escalates.
Having that separation, there’s a difference between you’re giving the patient your full attention and you’re taking the complaint seriously, but also keeping a distinction between your personal and private life and having the confidence to actually, ‘If you want to respond to my email, which was sent in office hours on a Friday, and you’re going to email me on a Saturday morning, well, you will be waiting until at least Monday, if not later, to get a response’. The other point I’d make is, is don’t get drawn into ping pong emails with patients. That’s where you can really encourage these malicious complainants because what they’re looking for often is, when it’s a truly malicious complainant, notwithstanding everything Andrew said about the fact which I totally agree with, it can be covering up other anxieties and problems underneath.
But if you have a truly malicious complainant, then pinging off an email, as soon as they’ve responded, they’re sat waiting for it, and you’re just playing the game. So you know, I will occasionally if I’m contacted by one of our members, I will encourage them to give it 48 hours to let the situation just slow down a bit. That can just help to move things in the right direction. But the final point I’d make and this is this is kind of going back to your earlier question, Rachel about the blame game, is sometimes it’s a shift in mindset necessary. Away from ‘we’re not here to win complaints’, that’s not the aim of the game, the aim of the game is to resolve complaints.
There is a subtle difference between those two concepts. If you can get your head around that, when you’re faced with those difficult patients. And you actually think, ‘Well, I’m not here to win a battle. I’m just here to resolve it, just to close that door so that the patients and I are happy to walk off in our separate directions and carry on with our lives.’
Dr Rachel: Andrew.
Dr Andrew: I think, just picking up on what George said, which is so important. It’s about resolving, not winning, and it’s about resolving loss, because we all go through loss, the patient’s going through loss, the practitioner’s going through loss. An understanding of the four phases of change with loss that we have to recognize loss, we then try and prevent loss, we then try and recover loss, and then we have to let go of loss. The stepping stones to grief that occurred during these the shock and denial that happened, as we recognize loss, the anger and the guilt that may happen as we’re trying to prevent the loss as we try and control the situation.
That’s where complaints come from, they don’t come in pre-contemplation. They come in the in the state of anger and guilt, recovering loss when there’s bargaining and bargaining can be either assertive, or it can be aggressive, or it can be passive-aggressive. The other phase that happens in recovery of losses is the flat state of low energy of depression. Finally, the letting go of acceptance. And these may sound like Kubler-Ross’s phases of grief, but they’re actually elaborated into the stepping stones of growth by a system called emotional logic, which I highly recommend, as a way of looking at growth and loss.
Both the patient and the practitioner are going through all these phases, as a complaint unfolds. As practitioners in the first place our challenges if we can resolve at the local level in either on a one to one with the patient or with our practice managers and others is to manage that process at the local level. When we fortunately have great defense societies and support, then that is still the process that is happening irrespective of the management of the facts. Because as George says, we want a patient who has closure, we don’t want one who has an open wound or a sore that can continually be irritated.
Dr Rachel: Yeah. And it’s it’s just learning to take this unpersonally. Is unpersonally a word? It’s depersonalizing. You would never take it personally, if a angry patient walked into the surgery and boxed the receptionist on the nose, right? You wouldn’t go, ‘Oh, I’m such a bad human being This is awful.’ It’s a terrible thing to happen, that patient is angry, they’ve taken out in a physically violent way, and you will deal with that physical violence and it’s completely unacceptable.
But if the patient isn’t a physically violent person, but they are then going to use that anger and take that out as a complaint, we then take that as a we then take it very, very personally, and sometimes, like I said, Andrew, just seeing what is going on under the surface and recognizing that they are angry for all sorts of reasons. They may have had a loss. There may be other stuff going on. Yes, it’s directed at you. But I guess, like you said, that is an occupational hazard. It’s part of your job as a health professional. It’s part of your professional role, sometimes to absorb that anger in the form of complaints. Now, I don’t like saying that. Would you agree that that’s true, Sam or not?
Dr Sam: It does come with the territory, sadly, and patients of course have a right to complain. I think one of the helpful things to let go of how it feels personally for you, is time. If you give yourself time to work it through, rather than responding immediately when the emotions are really high, I think that’s really helpful. Often what we do, what I do with my members is to talk them through it. As they understand, as they talk it through as they share it with their family and their friends and their co-workers, they begin to be able to say, this is actually not my issue, this is actually perhaps an issue for the complainant, and to be able to see it from a better perspective. I think it’s simply time and process that lets us let go of that personal offense that we take when people make these vexatious complaints.
Dr Rachel: Sarah.
Dr Sarah: I think that’s so that’s important. We talked in some of the earlier episodes about being kind to yourself, and I think what Sam and Andrew have said around recognizing the process, and I suppose the time that it takes to work through that is part of being kind to yourself. But also both everything I’ve said about how to reframe the complaint. So rather than taking it personally, rather than feeling you’ve got to win that, seeing it differently, and you’ve just said family be able to see it from a different perspective.
That is often the key, isn’t it, to be in a better position to then process and to get out of that mindset of having to defend yourself and prove yourself and win something. But instead to be able to see this as an opportunity for I suppose for growth, although that’s very difficult to see in the moment, I think. It’s only often afterwards, you can look back and see how, what you’ve learned from it and how that was helpful, perhaps for you, but also for other people who can learn from that same experience. A lot of what we’ve learned in Medicine and Dentistry, I’m sure has been, because we’ve learned from errors that have happened or mistakes that have come up that we’ve all sort of taken that learning and made changes as a result.
But I think it’s that shift in mindset, isn’t it from ‘I must win this, I must prove myself, and how dare the patients say that about me’, which is a normal reaction, to actually come into a point where we can see it differently another set from their perspective, and that doesn’t mean that they’re always right, or that we know we are a terrible person for what’s happened. But just being able to see it from that angle can help us I think shift what we’re wanting. I really like that whole concept of being able to see what’s behind their behavior. I often say to people, what’s, what’s going on for them, what’s behind that and not taking things at face value always.
Not everybody has got the communication skills to be able to manage themselves in a moment when they’re upset and angry. So the patient is expressing it and kind of show you how they feel. Perhaps they haven’t got the articulation or they’re too upset to be able to articulate in that moment, understand it in a way that would be easier to hear. So it’s trying to see past that. What are they trying to say? What’s going on for them? What are they wanting? And I think when someone’s angry, they often need to hear, ‘I can see how angry you are’. Someone said to me that it’s often helpful to say, and you’re probably worried as well. So you’re acknowledging that they’re angry. And also there’s likely to be anxiety behind that and you’re naming their emotions. And that can often help to, you know, just help them feel that you’ve got it. And they don’t need to keep on showing you how they feel. Because you’ve heard and you’ve understood.
Dr Sam: I think that at the end of the day, no matter how hard we try to resolve matters, no matter how good we are at reframing how good we are at understanding where the patients come from. There are some patients or some complainants who will never be satisfied. I think we need to recognize that sometimes you just need to agree to disagree. At some stage, that complaint has to peter out, it has to stop. But there are some times we will not find resolution and not to feel bad if that’s the case, it is just the way it is.
Dr Rachel: Andrew?
Dr Andrew: Sometimes in my work at the CCG, where I also deal with complaints at times, the personal meeting is useful. I don’t necessarily mean the personal meeting between the practitioner and the patient. Some times we’ve talked a little bit about vexatious. People have very strong feelings and they want to target those feelings. It’s inappropriate that that should be done in the personal situation. Sometimes it is appropriate, of course, for the practitioner to meet, to meet the patient. But we’ve facilitated meetings where I will share and we will have our complaints team and the patient, and we will try and go through all the facts and the story and explain. People want to be heard. And they do want to be able to tell their story, maybe to vent their anger and I’m quite happy for people to vent anger in a situation where I’m controlling the space.
Paper and emails don’t always allow that to happen. There is something about the personal contact on the personal relationship and sometimes the face to face, which in these days could be remote, rather than actually in the same room, which allows people to tell their story. We’ve talked about vexatious complainants. But the majority of complainants just want to know what happened and want to know an answer and may want an apology as well.
Dr Rachel: Yeah, thank you. So I’d like to move on just to talk about complaints in COVID. Because I think we talked about certain malicious complaints, we talked about what’s behind the thing that’s happening. And we have seen complaints going up in this post-pandemic, or at the end of, in the pandemic. But as we come out of lockdown, as things have opened up, there been many, many more complaints about really little trivial things. I’ve spoken to lots of people getting really very angry about all these complaints have been put in: patients complaining that they can’t get an appointment, even though they were offered one the day after they phoned up.
So being completely unreasonable. I guess sort of taking a step back, you can see that the, well the whole of the world has had a dreadful time, and everyone’s anxious and worried. And there’s lots of a lot of loss around this a lot of grief around. You can see how that could well be behind some of the complaints that coming in, as well as a lot of health anxiety about worried they’re not going to be seen when they need to be seen, but that’s turning into complaints. So is it right that we always deal with these COVID complaints in the same way, or do we try and minimize them? Or, you know, what would you advise? What advice would you have for practitioners specifically with these niggly COVID non complaints or when they’re complaining about something they really shouldn’t be complaining about? George, do you have any suggestions for people?
Dr George: Yeah, I think first and foremost, to your initial question, yes, I think you probably have to deal with them as you would for any other complaints. And although it might, to you, be trivial, and you might think, well, it’s an unavoidable effect of the pandemic. Yes, I think you should still follow the process, you should still do all the good things we’ve spoken about, about listening to the patient, acknowledging their concerns, and apologizing and so forth. But yeah, the pandemic has given us a really unusual situation where, if you take dentistry, we’ve seen a number of complaints arise out of the first wave, where practices were told to close, and patients are unhappy that they couldn’t be seen.
Now that, to me, is really an open and shut case. We were doing exactly as we were told, by the government at that time, and there isn’t a lot that we can do about it. So I think, deal with them in the usual way. But you sometimes, we’ve spoken about apportioning blame, and so forth, don’t be afraid to just be a little bit more robust in your response with the patient sometimes, and state it how it is. Once you’ve given that explanation, you know, we were following guidelines, this happened because of these reasons. You can acknowledge where there is some learning to have taken place, perhaps you didn’t communicate the closure, as well as you could have done to patients, or you didn’t put in sufficient means for the patient to contact you for telephone advice. There’s always some learning in the complaint there. I think if you can add some of that into the mix for patients, then that goes a long way to helping to resolve the situation as well.
But yeah, it’s, gosh, hasn’t it been a tough year for healthcare providers, and for patients too. We need to recognize that, I think. You can, and sometimes that parent whose child is sick, that half-past five on a Friday evening, that’s just at their breaking point, maybe you get the brunt of it. Separating that person out from the problem can be very helpful. I think particular COVID complaints are concerned that there is a real benefit. It’s not something we’ve really touched on today, so far in, in sharing with the team, and sharing that learning with the team. What I would say is, particularly if you’re getting a lot of similar complaints, sit around a table, get everyone around the table in the practice and in the hospital team, and talk about how you can deal with these in a consistent manner, because there will be some common themes.
If you’re getting a number of complaints about difficulty accessing care, or a number of complaints about the delay in diagnosis, you can come up with a strategy on how you’re going to always fast-track those complaints. So you can you can you know, you’ve got your unusual outliers that will need a little bit more careful thought but if you’ve got a patient that says, ‘I couldn’t get a GP appointment at four o’clock on a Thursday’, you can come up with a pretty robust well considered standardized response with a personal touch, of course, that will just help streamline that because we’ve all got enough work to do. Without having to deal with the burden of all of these complaints as well.
I think just sometimes sharing that learning in the team, sharing the burden can be really helpful. And just a final point, Rachel, if I may, we find actually, where I work, some of the more junior members of the team have a real talent for de-escalating complaints. So we sometimes think it’s got to be the most senior person in the team that deals with these things. And yes, you need that oversight. But don’t be afraid to actually search out that talent, because we can talk about the tips and the strategies. But I do think some people have more of a natural flair for that separating out the remaining objective, the calm tone that Andrew did so well before.
I am one of these natural people that that does get a bit agitated. If you’re angry and loud with me, I’ll risk getting angry and loud with you. So I can see those in the team that are really good at de-escalating. So they will be the the first port of call with a patient that’s complaining and often that goes a long way to helping to nip things in the bud.
Dr Rachel: I like that idea of sort of actually nominating one person, actually, you’re the person that’s going to deal with all this and obviously given the appropriate support and stuff. But rather than everybody having to deal with all of these little niggly complaints, if you give someone the time, the training, you get together, you agree what you’re going to say, and that person is really good at it and might actually really enjoy trying to resolve things that take some of the pressure off of the rest of the team. Is that something that other people would advise as well?
Dr Sam: I think that’s a really, really helpful way of looking at it, and they actually utilize people’s and skills and talents. But also, and also having that team approach is so helpful, because it does take its toll on the team, because there’s lots of complaints coming through, and therefore getting together as a team, sharing the experience. Moving forward, okay, so what are we going to do about this? And not just I mean, it’s understandable to have a bit of a, oh, my goodness, this is awful. Why is all this happening? I’m sure there’s been a lot of that having to go on in terms of that sort of peer support. But then, okay, so what are we going to do about this in our team? How are we going to best respond to these situations? And how, and who is the best person to manage that? And I think that’s the way of looking at it, maybe isn’t it as a team. How are we going to tackle this together, then you don’t feel that you’re on your own. I think that’s really important.
Dr Andrew: Just to give an overview, if I may, on the epidemic of complaints, I work for a couple of organizations where we’ve seen more complaints in the last six months than we’ve seen in several years. Society has been going through great loss, and the reactions, our autonomic nervous system freeze, and we have been frozen in fear for a year of lockdown. As we come out of fear, we want to try and recover the loss. This recovery of loss, the anger and the guilt is being targeted. Wherever we’ve experienced the loss in our life, whether that’s being unable to see friends and family, being unable to move freely around the country, being unable to go abroad, being unable to connect with people, and we still have those feelings inside churning around. It may well get actually targeted into something that actually seems quite trivial, such as being unable to get the appointment on Thursday afternoon at four o’clock as opposed to Wednesday. But they are human beings with feelings, and this is society. And this is what everybody is going through. I fully agree with George, Sarah, and Sam, that we always need a professional response because there’s a person behind it. But we also have to have the understanding, this is what society is going through at the moment, these times of pandemic and people adjusting to change and loss.
Dr Rachel: Yeah, totally. We’re very nearly out of time. But I just have one question to finish off with if that’s okay, and this is about if you’re supervising someone else who has a complaint, because many of our listeners are trainers, they’re educational supervisors, they might be training program directors, or they might just be responsible for some juniors in the team. It’s really hard to have a conversation with a trainee who’s received a complaint because when you’re very junior, you do take it incredibly personally. It might be the first time they’ve ever had a complaint, they might feel like the world is coming to an end, they may feel like that, because you’re their supervisor that’s going to reflect badly on them in terms of their training portfolio and, and things like that. So how would you suggest that they approach having a conversation about this with them. Sam, what would you suggest?
Dr Sam: Yeah, I regularly see that our members can react and one of two extremes: the whole anger or the fall on your sword, and unfortunately neither tends to be particularly helpful. But as a supervisor, what I would suggest is that you recognize that the person in front of you is struggling to cope and what they need is actually reassurance. To know that you are with them, to know that you’re supportive of them. I would start with just acknowledging the feelings that they have, and why there’s the feeling like that, so they can feel heard.
I think it’s really helpful for them to know that the reaction is really common, that a lot of the colleagues would react in exactly the same way. So it helps them to feel like, oh my colleagues do get complaints, and they react in the same way as me, and then I’m normal. And then I would suggest that you try and put the complaint into its context. When you get a complaint, it can feel overwhelming, and most doctors will go to that place of ‘Gosh, I must be a terrible doctor, I’m no good at what I do’, or a dentist would feel that way too. In reality, it might actually only be a minor complaint.
Often, what I would do is advise around the seriousness, is this a serious complaint, or do I actually think it’s something minor, and therefore, I can reassure them that they don’t, they don’t need to be overly worried. And I think that once, even if it is a serious complaint, you think, gosh, there is quite a lot of vulnerability here. I often reassure them that one, I’m going to walk through the problem with them every step of the way. That often, once we know what the facts are, then you can actually feel better because you feel more in control. Also, I let people know, this is the possible process here to view so that they’re not left thinking, gosh, I’m going to be struck off. Because it’s often what doctors feel, I’m not going to be able to practice anymore. Once I’ve gone through that, then often I sit them off doing a task, you know, find out what the what the facts are and begin to investigate. And I think it means that they can redirect the energy into doing something that’s constructive and positive.
Dr Rachel: Thank you. Sarah.
Dr Sarah: Yeah, I think what’s really helpful to think about when you’re the educational supervisor or the trainer, is going back to when I was in that situation, what would I have needed from my supervisor or trainer? And then with all the learning that you have, as you’re in your experience? How can you take that learning into them the way that you approach it. So agree with everything that Sam said, and the three sort of words I would think about is I’m going to approach this to create a safe, supportive space. So it’s about creating psychological safety so that the trainee feels that they can open up and be honest with you. Often you do that by reassurance, but also by being vulnerable yourself, as Sam said, normalizing the fact that you’ve had errors and made mistakes as well, and you understand how they feel. But that’s support to show that you’re alongside them. But there’s space for them to process what they’re going through. So I think if you approach it in that way, thinking what would I have needed when I was a trainee? What do they need from me? Creating that safe supportive space for me, that would go a long way.
Dr Rachel: Andrew.
Dr Andrew: Doctors reflect, dentists reflect, as professionals, we all reflect. Actually, sometimes we ruminate. Rather than reflect we don’t give ourselves closure. So I agree entirely with what what Sam and Sarah are saying, take it seriously as a supervisor, make time, help your colleague, your your trainee, yours, the person you’re supporting, help them know that you have got their back and support, support support. You understand the process more than they do, you’ve got a much longer perspective.
Remember that most doctors, most dentists, most professionals actually suffer from imposter syndrome as well. You have to name these as you’re helping support the person because if you name them, you’re taking these these hidden tigers, these fears that are in the cupboard, you’re able to expose them and show them as part of what we feel, but not really what’s the facts of how we are and how we are as professionals.
Dr Rachel: George, does this work for dentists as well?
Dr George: Yeah, I think all good points made and I think that they need to be in the right time and space to have that conversation first and foremost. If the complaint has just come in. I used to be an educational supervisor myself and I’d want to get right to the bottom of it straightaway. I’d have a gap now I’ve got an hour’s time. Let’s deal with this now so I can get it off my plate. But actually that’s sometimes the worst thing you can do for the person that received the complaint because you know, they want to go and have a think about it and reflect.
So the time and space so that you’re doing it at you know, a suitable moment for the person that’s received it, asking what their concerns are, I think is a great shout because actually they might be most upset or angry or anxious about your perception of them and how it is going to change how you view them. Which leads me on to my third point and the best trick I ever found, when I was supervising someone that had a complaint, is tell them about a complaint I’ve received, we’ve all had that. So actually dropped down that, just just lower that barrier of I am perfect, and I can’t make mistakes.
Tell them about a complaint that you had in your career, maybe even one that you had last week as a consultant. You’ll be surprised how much that breaks down those barriers to the relationship and actually makes you seem a little bit more human. And then you’ve got the training that things are, well actually, if you did that, actually what I did wasn’t so bad. And maybe there is an opportunity here to, to learn from this and grow as a professional and the future isn’t as bleak as it looked five minutes ago.
Dr Rachel: That’s so true. And that’s what they was talking about with the vulnerability now, if you share stuff that you’ve gone through, then absolutely, they’ll go, ‘Okay, well, gosh, if if you can make a mistake, then that, then I can make a mistake’. It’s what our colleague Annalene Weston was saying right in Episode One. She teaches her dental students to say, at university, I am going to make mistakes, and some of them are going to be serious, and just sort of learning that right from the get go.
But that means that you need to admit and talk about it. I guess what you need to be doing is at practice, or at wherever you work, is before your trainee gets complaints. You all are sharing the complaints that you’ve had. So it becomes the normal thing that you talk about, and you share. And so when they do get that complaint, it’s not like this massive bombshell of, oh, my goodness, this this has happened. It’s like okay, well, okay, this is the first one it’s come along. I was almost supposed to be expecting this really. What do you think, Andrew?
Dr Andrew: I completely agree. Nothing to add to that. You’ve put it so nicely. Thank you very much.
Dr Rachel: George, as you were speaking as well, when you say they actually find out they’re the trainees’ concerns that we have that that lovely phrase is that we that that trainees learn how to find out their patients ideas, concerns and expectations. But actually, in all of these complaints, we need to be finding out what our trainees, what are their ideas, concerns, their expectations? What are the patient’s ideas, concerns, and expectations about a complaint? That’s going to stand you in, in pretty good stead.
So I think we’re at the end of our time, I’m going to go round and ask you just for one top tip, each of you, for people when, what would you like people to go away with? Really knowing when it comes to managing themselves or dealing with complaints? Give me a wave, whoever’s got the first tip, and I’ll come to you first. George.
Dr George: I’ll get in first before others steal my idea, Rachel, I think, and by the way, thank you for having me along today. It’s been a real pleasure. And don’t bury your head in the sand. No one ever resolved a complaint from burying their head in the sand. You’re not alone in this. Speak to your colleagues and take advice. It wouldn’t be right, if coming from an indemnity provider, I didn’t say, pick up the phone to your indemnity provider, we’re here to help. You know, we’ve all been there. You’ve got colleagues that you will be surprised how much they fall over themselves to help you when you find yourself in this position.
Dr Rachel: Thank you, Andrew.
Dr Andrew: It’s been a privilege to be with everyone today. Just two words: stay calm.
Dr Rachel: Thank you. Sarah.
Dr Sarah: I think asking yourself, what’s behind the situation, both of yourself, the other person, is often a really helpful way just to reframe it. Along with everything else that everyone said. And thanks again, for having me on the panel.
Dr Rachel: Thank you. And last but very not least, Sam.
Dr Sam: Only, I would say you will get through it. I think it can feel at the beginning of the process that it can feel like this huge mountain, but you will get through it. The overwhelming majority of doctors and dentists, I’m sure, go on to have a very successful career. Look at it from that wider perspective of life. So thank you very much for having me, Rachel. It’s been a real pleasure to be on the panel with you.
Dr Rachel: All right. So it will pass whatever it is. Thank you guys. That was absolutely brilliant. I think we could probably talk for another couple of hours about that. So it’s just been really good to have you here. Thank you so much for giving up your time, just to say to listeners, if you have any further questions or anything, do submit them. I’m sure we can get people back on podcast for future episodes because this is a conversation I think we need to keep on having about complaints. I don’t think we talk about them enough and I think we need to normalize them. We need to manage ourselves better when we get them and just realize that it’s part of our professional responsibility. So thank you for listening.
Do get in touch and do remember that if you are struggling with any of this, please contact with your own GP, contact practitioner health. Contact your employee assistance program, speak to colleagues. Get some help, don’t suffer alone. Of course all the medical defense organizations are there to support you. They’re there to offer advice and contact them sooner rather than later. Is that what you’d say guys?
Dr Rachel: Great. So thanks for being here. And we’ll speak soon. Bye Bye.
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