Complaints and How to Survive Them E3: Surviving the Process

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, I’m talking to Dr Jess Harland, a GP partner and trainer and a PCN Clinical Director, Dr Caroline Walker, aka The Joyful Doctor, who’s a psychiatrist, and Dr Heidi Mounsey, a medicolegal consultant for medical protection, about how to survive when you make a mistake or deal with a complaint. We discussed the many emotions such as anger and shame that we may feel and the types of response which can make us feel much worse. Whilst it’s never going to be easy, there are some things you can do to get more control and feel better. So listen if you want to find out the common emotions you will experience, and why we find it so difficult, how to limit the amount of time you spend ruminating on what’s going on, and some simple strategies for managing yourself so you don’t feel so battered and bruised by the process of going through a complaint.

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, then do join our Permission to Thrive CPD membership, giving you webinars and CPD coaching workbooks which will help transform your working life. Links 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 with not just the legal stuff, but your emotional and mental well being too, from expert medical and dental legal teams to independent counselling, through to 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 at medicalprotection.org, and dentalprotection.org. And now, here’s the episode.

Welcome to another episode in our series on surviving complaints. And this episode is all about actually how to look after yourself and what to do whilst you’re going through a complaint, how to survive that. And I’m really, really pleased to have me on this episode with me. First of all, Dr Jessica Harland. Welcome, Jess.

Dr Jessica Harland: Hi.

Rachel: Jessica’s a GP partner, and she practised in London. She has, obviously, a lot of patience. And as part of, you know, running practices deals with complaints a lot. She’s a GP trainer. She’s a PCM clinical director, and she’s able to give us a really brilliant clinical perspective from the coalface. Thank you so much for being with us. I’m also really, really pleased to welcome Dr Heidi Mounsey. Now, Heidi is a medicolegal consultant for MPS. She has a background in anaesthetics and palliative care where she works as a doctor there. So she’s got a wealth of experience, working in hospitals, and also now helping people as they go through complaints. So welcome, Heidi.

Heidi: Mounsey: Thank you for inviting me.

Rachel: And also it’s a great pleasure to have with me back my colleague, Caroline Walker, Dr Caroline Walker, who is an NHS trained psychiatrist and therapist, and she now specialises in doctors’ wellbeing, she founded The Joyful Doctor. And she also works with practitioner health, and supports a lot of doctors who are going through the complaints process. So, Caroline, good to have you with us as well.

Dr Caroline Walker: Great to be here, Rachel, thanks for having me.

Rachel: So I wanted first, I think, to start off with by saying, we, I hear very little about complaints? I think doctors don’t like talking about them. Yes, we all know people that are either going through complaints at the moment, or certainly have had one, often people have had nasty complaints. And I think it’s really prevalent, but actually, we’re not sharing it. We’re not talking about it very much. And actually, I’ve had some trouble finding people who are willing to really share their stories, because I think people feel embarrassed, feel all these sorts of different emotions that we go through with complaints, which is why I think it’s so so important to talk about it. And I just really want to ask each of you really, what’s been your experience of either going through stuff or supporting people who’ve been going through stuff. Caroline, you see lots of lots of doctors, and particularly doctors in quite a lot of distress, don’t you?

Caroline: Yes, absolutely. And I just want to echo what you’ve shared there, Rachel, that complaints are just a very, very normal, common part of being a doctor, in our medical lives, but they can feel incredibly isolating. When you’re going through one, it can feel like you’re the only person that’s ever happened to, and it’s ever going to happen to you. But please, if you’re listening to this, and you’ve had a complaint or you’re worried about getting a complaint, please know you’re not alone. It’s incredibly common.

Rachel: It’s interesting. On other podcast episodes that we’ve recorded, we’ve been talking about the fact that it is just an occupational hazard, you know, if you wash enough dishes, you’re going to, you’re going to drop a couple of them. But we don’t have that mindset. Really, do we ever come back about that in a second. But Jess, how, what’s your sort of experience in this whole area?

Jessica: Well, I’m really glad you’re talking about this topic. today. Like many doctors, I’ve had a steady trickle of complaints over my career. I think I got my first complaint in my house or my first house job, which was absolutely mortifying, devastating. And later on, as a GP, they do come in from time to time, you get that email with the heading, Subject: Complaint, and you get a tachycardia. And your stomach drops through, through the floor. And very often that the only person you talk to about it really is the practice manager who, you know, quite understandably just wants to get it dealt with and, and move on. But what I now have later on in my career is the perspective of being able to see that everybody else is getting complaints as well. And you know, there are some doctors, I can tell you, who get one every other month. And I really am grateful for the opportunity to share that experience because I would have really appreciated that in my earlier days where you, as Caroline said, you feel like you’re the only one it’s happening to and everybody thinks you’re a terrible doctor and your questioning your career choices and it really doesn’t have to be that way.

Rachel: Thank you That’s so interesting that it goes on a lot but we just don’t mention we don’t we don’t know about it the way and Heidi you obviously deal with lots of doctors when they come to you for advice.

Heidi: Yes, so my role is supporting doctors going through the complaints process on a very, on a very practical level and I agree completely with what Jess has said. People do come to us and they say, ‘I’m I’m so ashamed that I’ve got this complaint. I’m really upset by it. I don’t know what to do’. And I advise and guide them through their through the practicalities of approaching a response to a complainant, I will review their response to complainants before it goes out, I can make suggestions as to how best to approach the matter to try and avoid it escalating, that it’s clearly a frustrating and distressing process for individuals. And it does add a lot of stress, it is very time consuming. And what I like to think that I can help with is just to reduce that stress, and perhaps even reduce the amount of time that it takes if we can resolve a complaint to the satisfaction of the complainant with the first response, for example, so that it doesn’t drag on and it doesn’t escalate.

Rachel: That’s what we all want, right? Is it just to be done and dusted, and for it to go away? No, no more, obviously doesn’t always happen like that, does it? Why do you think we don’t share this with our colleagues, we don’t talk about it much. Given that it is an occupational hazard, and most people get them, why don’t we talk about it more?

Jessica: I think that’s a really good question. I think it depends a little bit on the nature of the complaint, where it’s sort of a system complaint or general frustration with everything sort of thing that’s fairly easy to deal with. But sometimes complaints can be quite personal, about your professionalism. And I think particularly if the complaint has come out of the blue, and you felt that the consultation was going fine, and you’re in control, and then somebody tells you that actually, you haven’t done a very good job. That’s very uncomfortable.

And I’ve been reflecting on a sort of bigger theme, which is that as healthcare professionals, often, so much of our sense of self, our self esteem, our status in our families, in our society, is based on our profession and our career, that when somebody criticises you, and it’s very much you personally, it’s extremely painful. And if you feel that your professionalism has been brought into doubt, I think that’s understandably something that people don’t necessarily want to share.

Rachel: So it’s this implied feeling that we’ve been criticised, and that actually, we may have done something dreadfully heinously wrong. And I think perhaps it’s our own inner critic that’s stopping us as well as more about what other people might think.

Jessica: Partly? I think, perhaps sometimes we are a bit judgemental about colleagues, that probably contributes. I think there’s something also about our own status as a professional, and we like to think that we are in charge, and we’re in control of the situation. And when somebody takes back some of that control, and you’re sort of demoted, I think that can be quite difficult to deal with as well. It’s quite humbling. And that takes some adjustment.

Rachel: It’s very difficult to think that we have, you know, failed in our professional duty or made that mistake. We don’t give ourselves much of a break. So we don’t make allowances for ourselves and allowances that not everyone is 100% perfect all the time. I mean, Caroline, I’d love to ask you, what sort of emotions do we, do you see with people that are going through complaints for the people that are really, really struggling?

Caroline: So we see I see a lot of really common similar emotions and reactions from doctors, when they go through a complaint process. Guilt and shame comes tumbling into the room straightaway, usually whether or not they have done anything wrong. There’s often a lot of anger and frustration at how the complaint came about, or how it’s been handled since, or that simply how long it’s taking to resolve. I see quite a lot of anxiety about getting more complaints, getting other complaints, and lots of doctors then changing their practice to try to avoid anything else going wrong. And I also see quite a bit of grief, or kind of sense of the doctor sort of feeling like they’ve lost their relationship with medicine that they have before. This is something they’ve wanted to do their whole lives quite often, and they thought was going to be this incredibly rewarding and wonderful career and sometimes something like a big complaint comes along and it can completely take over for several months, sometimes even several years. I’ve worked with a couple of doctors recently who had a complaint maybe three, four years ago. We’re still carrying that burden, the emotional burden of it with them today. So I think yeah, I mean a whole range of emotion. But I’d say the commonest ones are the shame and guilt, anger, frustration, anxiety, and perhaps a sense of grief or loss.

Jessica: And so I would add that I think a very common emotion initially is defensiveness, and blaming the complainant. And I actually think that that’s something we will have to do. I think it’s part of process that you go through, that it wasn’t me, this is absolutely unreasonable. You go through that as part of your coping strategy. But I think it is quite important to be able to move to the next stage, which is to have a little bit more understanding of the perspective of the complainant.

Caroline: Yeah, I’d agree, Jess, and I think often that initial defensiveness is covering up the anxiety is covering up that, ‘Oh, my god, did I actually do something really wrong here? Or something terrible gonna happen to me? Am I going to lose my licence? Am I going to, you know, get into trouble here, am I going to lose my job?’ Things like that. Naturally, we want to avoid that at all costs, so we want to put the blame elsewhere. But actually part of the process, particularly if you have been responsible for something going wrong, is coming to an acceptance around that, and seeing other people’s perspectives.

Rachel: That’s really hard, right? I’m just thinking, when I’ve had complaints in the past, you look back and you think, right, what happened there, and you look back and go, ‘Oh, thank God, it wasn’t really my fault! Shoo, that lets me off the hook’. But what about those times where you genuinely did make a mistake, something went wrong and something bad has happened? You do feel genuinely bad, and it was your fault. How do you even begin to start to cope with those emotions, that crushing guilt, and then the shame?

Caroline: I think this comes back to what Jess was saying that over time, you, you start, you have to lower your expectations of yourself, essentially. So as doctors, we have these ridiculously high expectations that we’re all going to be perfect and never make big mistakes. And, and actually, of course, we’re not, we’re human, right? We all make mistakes, I’ve made big mistakes, it’s, and I think when we start to lower those, or adjust those expectations of ourselves and get a bit more realistic, because actually, it’s okay. All right, you know, when you start to talk about other people, to other people who’ve made mistakes, that really normalises it takes a bit of the shame out of it, you can start to treat yourself like every other human being that you treat really kindly and compassionately. You can say, okay, yeah, I made a mistake. I’ve got it wrong. But I’m gonna learn from that.

Jessica: A couple of things. I always say when I’m talking through a complaint with a colleague or registrar, first thing is I always say, ‘Great, you’ve got something to talk to your appraiser about now. There’s nothing too dreadful. What you want is the sort of fairly minor complaint that you can reflect on and pad out your appraisal with’. But secondly, CQC loves complaints. CQC are fascinated by the complaints that you’ve had. For everyone who doesn’t know what’s the CQC is that’s the Care Quality Commission. And what they’re really interested in is patient safety, quite rightly. And what they really want to know is when you’ve had complaints, or if you’ve had complaints, but when you’ve had complaints, how have you, as an organisation, responded to those, and if you can show that you have learnt from them, and shared the learning with your team that scores really well in their eyes. So I actually think one of the things that’s going to be really important in normalising and coping with complaints is that organisations are much more proactive in sharing complaints and talking about complaints.

Rachel: Yeah, 100% agree. And it’s sort of it’s changing that mindset, isn’t it from, ‘Oh, no, I’ve done something wrong, too. Oh, good. I can learn from this. And we can make everything better for everybody, including the patient.’ Exactly. This is a learning thing.

Heidi: I think in a lot of cases, it’s not that the doctor or the healthcare professional, has done something wrong. Often a lot of complaints arise as a result of miscommunication. And complaints can be very, very personal and absolutely scathing. And you are expected to maintain your professionalism and respond to this in a very factual and objective way. And that can be very difficult.

Jessica: I would say complaints are almost always about communication. And Heidi, yes, that’s definitely been my experience when I’ve been overseeing everyone’s complaints.

But sometimes I’m sure you will feel like I want to complain about you. Where is the organisation that I can send my letter of complaint to? Your behaviour is vile. and I think Heidi will know more about this, but in terms of what’s required and how we respond to complaints that if you feel that complaints are repeatedly antagonistic, or I can’t remember the exact phrase they use, you can

Heidi: Vexatious.

Jessica: Vexatious, that’s a great word. Yeah, you can decline to respond, I think.

Caroline: That’s lovely. That’s a really good example of gaining a little bit of control back in the situation. Net, because complaints are fundamentally a situation where something’s come along, often out of the blue, where you feel like it’s out of your control, something’s happening to you that might kind of spin even further out of control. And that’s where the anxiety comes in, and the fear. So to actually be able to look at it in that way, reframe it and go, well hang on a minute, I’ve got a choice here about how I respond to this complaint is really empowering for a doctor.

Rachel: That’s a really good point, Caroline, because I was reflecting. One of the reasons why I wanted to do this series was I have a colleague and a friend, and she had a dreadful complaint last year. And actually it, when we look back, it wasn’t really much to do with her. But it, they, the complainant came, it felt like they were coming after her. It all got done and dusted him and it was okay. But for those nine months, when she was going for it, she was a very senior GP, okay. She’d had complaints before, but it completely floored her and she was anxious. She wasn’t sleeping, she just wasn’t doing it.

I mean, lockdown didn’t help, of course. But I just observed this person and thought this is not, this is not right, you know, I could see this person almost on the edge of taking time off work with stress. And I know that happens a lot with people. And I thought actually, there must be a better way to do this. And I think sort of seeing it’s an occupational hazard and having some training and almost making a plan of how you’re going to do it, how you’re going to respond and manage before it happens, how can we do that?

And I just wanted to ask you, what difference can you see between people that seem to be coping pretty well through the complaints process, and people that really aren’t coping very well? Well, is there any difference? Can you see them doing things differently in terms of looking after themselves and managing themselves? Or is it slightly random?

Heidi: I think there is a difference, I would say that one of the one of the differences is how the complaint is written, which obviously the doctor themselves or the healthcare professional has no control over. But a complaint that is about systems and process and a complaint that is, in itself, quite factually and objectively written, is a lot easier for someone to handle than a complaint which says, ‘You are wrong, you are a horrible person, I don’t like you, and my loved one is dead because of something you have done or something you didn’t do’. And that second approach prompts a much more, I think, visceral reaction in the healthcare professional. And it tends to lead to, I would say, there are two extremes. I mean, obviously, there is a spectrum.

But that sort of complaint, I think tends to lead to two extremes of response: One is that this is completely unjustified. I have done nothing wrong. How dare you complain about me like that. This is absolutely not fair. Go away, I’m not even going to bother responding to this, this is so inappropriate. And they are defensive, and they are angry, whether or not there’s anything actually there in the complaint that’s justifiable. And the second extreme are those that kind of go, Well, I am responsible, I killed this person, this person is dead because of something I have done. Whether that’s true or not, that’s what they’re thinking. And they come to me, they phone me up that I’m going to have to leave the medical profession. I can’t, I can’t go on like this, this is my fault, and they want to fall on the sword. They want to write a letter, which just apologises and says yes, you’re right. I did all these terrible things.

And for both of those extremes, part of my role is to unpick what the complainant is actually saying, and how the healthcare professional sees what is actually being said here. What is this person’s concerns? What are they worried about? What are they really complaining? Is this an outpouring of their own grief? Perhaps. And then you need to take that into account when you’re thinking about the when you’re thinking about the response. So I think people do get very distressed, and that emotion comes out in a number of different ways. But I would say those are the two extremes we see when a complaint is deeply personal.

When a complaint is systems or process only, why did it take the hospital this long to process my referral? Why did it take you three days to write the referral to the hospital? Why did the receptionist tell me that my blood results were normal when actually, you know, my sodium was a tiny bit raised? I think those are far less personal. They’re a lot easier to deal with. Or even when it is something that’s occurred within the consultation. You said I had this, and actually I’ve been to the hospital and I’ve got cancer. Why didn’t you tell me it was cancer? it’s put in a very factual way. It’s put in a very objective way. and the doctor is then able to write back to the patient and say, ‘Well, I didn’t know it was cancer. But that was my concern, and so that’s why I’ve referred you to the hospital.’

I think people are able to manage those complaints much more easily. There’s a rational, it’s a rational complaint to start with. And there is a clear explanation that the doctor can give. And I would say, actually, that probably that the way that the complaint is written really does have a tremendous impact on how the doctor responds and how the doctor is able to deal with that.

Rachel: That feels quite powerless to me, though, because we’re not in control of how the complaint is, is written. And so I guess, you just got to hope that you get the good complaints. A, but then there must be something even if it’s written really badly, that we actually are in control. Jess, what’s your experience of all of this?

Jessica: I think what Heidi said there is so insightful, and I think it’s lovely that you shared that experience with us about, you know, the example of this, this letter could well be an outpouring of the complainant’s own grief. And I think the protection organisations are always fantastically constructive and helpful when you do contact them. But of course, how much you can support individuals is limited. And I think if you feel stuck, and you feel like you are unable to move forward and still internalising all the criticism, and what have you, that I think we must feel able to reach out and debrief with somebody to get more, well, just another perspective. And fortunately, in dental practice with fairly well provided for that, and Caroline, I’m sure will have suggestions about who to speak to if you don’t have anyone immediately within your organisation.

Caroline: Yeah, absolutely. I mean, the first people I would point doctors in this country towards this practitioner health, NHS practitioner health. A free and confidential service that can support you through the emotional impact of receiving a complaint. And I think what you both mentioned there around perspective is really, really important, because when a doctor receives a complaint, often it’s received as like a one way attack, as if the complainer is complaining about you. And it’s directly at you. And actually, I find it really helpful to remember that there’s three things going on here, not two. There’s not them and you; there’s there’s them, and what’s happened, and how they’re saying it as you, but there’s also the thing that has happened.

And if you can take that thing that has happened slightly off and away from you and look at it with a bit more perspective, it often helps to relieve some of that, you know, this is personal to me, this is about me as a person. It’s actually about something we can both look at and learn from together.

Jessica: Another thing I try to encourage people to think about, and I’m saying all this, you know, I’m coaching myself through this as well, because I obviously go through this process myself, but I think it’s important to remember in any doctor-patient situation or doctor-relative situation, there is a power differential. And the doctor is perceived as having all the control by the patient or the relative. And often if you, particularly if the complaint is about something that you’ve said no to or haven’t agreed to, or you decided on one course of action when they wanted another course of action, I think often especially when there’s been a conflict, and you have kind of reached an impasse, you have to remember the only route left to the patient at that point is really to complain. It’s always because they just pick up the phone, we have a conversation. It’s not that easy, is it, really, to connect with your GP. There’s always layers of protection and barriers that they have to get through to get their voice heard. So I think having some awareness of that can help you feel a little more sympathetic to the complainant as well.

Rachel: So that thing about sort of being able to depersonalise it suppose to the person from the problem and realising, yeah, that actually in their case, this may be the only route that they that they can see they want to lash out at something and blame something because they’ve got their own stuff to deal with. I think that can be really helpful. It’s quite hard to depersonalise stuff on your own. I find talking to a friend or a colleague is much easier than intensive debriefing.

Caroline: All of these feelings breed and get worse in silence. You know, feeling guilty, feeling ashamed, feeling angry, feeling anxious — they all get worse in silence. And if you’re just trying to deal with them on your own, whereas actually just talking through with someone that it’s a friend, family member or a professional colleague, it will help to ease it. It may not be the easiest conversation you’ve ever started in your life, but it gets easier, the more you talk about it.

Heidi: So no, I would completely agree. And again, you know, whoever is handling the complaint for you, if you contact your indemnity organisation, they will have seen a lot of complaints, they are very happy to help people gain that perspective. And again, your indemnity organisation can also point you in the direction of additional help if that is needed. And they are an objective body. They will be able to say, Well, what was the rationale for doing this particular thing at this particular time? How can we put that in this response to the patient?

And they will also, I would always encourage people to offer an apology, even if they don’t think the complaint is particularly justified. Even if they’re just offering an apology to say, well, ‘I’m sorry you’ve had cause to write this complaint’, even if they can address every clinical point that’s raised in the complaint, offering an apology goes a long way. I don’t know whether Caroline or Jess have any views on this. But I think that’s something that people find very difficult to do when they don’t think an apology is necessarily warranted.

Caroline: I think offering an apology, when you don’t think it’s warranted is incredibly hard. I mean, we’ve all had arguments with loved ones, haven’t we, our friends are like, No, I’m not gonna back down, you know, but I do agree it’s an important part of the healing process, but often you come to it later than would be ideal. So sometimes doing it through gritted teeth can be helpful to begin with, and then later, you feel it a little bit more genuinely, as you process the emotions and what’s happened. And, yeah, come to an acceptance of the different perspectives.

Rachel: Yeah, I guess that’s something you are in control of, isn’t it? Like you said that one of the big problems or complaints is you just feel out of control, it’s all gone out of your control? Often, there’s investigations going on, that you can’t do anything about, apart from, you know, documenting and how you communicate with the patient. But I think that, then that’s that becomes really, really important, actually, what can you control and what you’re gonna do with that thing that you can control? And how you can get, make the most out of it? Yeah, Jess, what do you think?

Jessica: In terms of starting to assert some control, I think a good way to start tackling the complaint, try to break down the complaint into specific bits that they’re complaining about, and and try and do numbered points. And then you can start to address those, specifically. And so you’re sort of when it can feel quite overwhelming, and you don’t really know how to start. I think that’s quite a good way to get going.

Rachel: And we’ve actually recorded a whole episode on you know, what to do in that moment when you get that complaint. Now, what should you do in this and fantastic advice in that other episode. What I’d like to move on to talk about now is actually, how do you look after yourself when you’re going through a complaint? Because I just, like I said, I’ve seen people go off sick, I’ve seen people falling apart, there’s been some very tragic stories of people, doctors committing suicide whilst they’ve been going through the complaints process. That’s just an awful, awful state of affairs. I mean, just sort of looking back at maybe complaints that you’ve been through personally, what do you wish you’d known at the beginning that you know now, that you’d sort of go back and say to your past self, this is what I’d do differently. This is what I’d do. In terms of looking after yourself.

Jessica: I don’t know what I’d do differently. I think it’s just having a better awareness of why complaints arise that makes it easier these days. But definitely talking through it with somebody is something we’ve talked about already. I think another thing to bear in mind is that it may be that if you were feeling in control of everything else, you would be able to deal with that complaint perfectly well. But if that complaint happens to come along at a time when you’re feeling under pressure in other ways, and actually, that pressure has probably contributed to the complaint arising in the first place, then it can really tip you over the edge. And I think, I don’t want to have everyone go sick at all, but I think if you feel you need a break, take a break. I think as doctors we were absolutely allergic to the idea of not coping and having to just push on through. But if you’re crying every day before going to work or if you’re not sleeping night after night, you need to take some time out, and I think act on that.

Rachel: That’s fantastic advice and just thinking even if you don’t actually take time off work, you maybe need to look at your schedule and think Is there anything I need to drop right now just need to get off my plate to give myself some emotional time and headspace to be able to process this. Caroline is that sort of advice you give people?

Caroline: Yeah, 100% I mean, complaints tend to be things that fill our brains very, very quickly. And we start to get really preoccupied by them. We’re thinking about them all the time, we’re carrying them with us everywhere. And, and it can be very, very easy to drop your basic self care, actually, you can say, miss meals, go to bed a bit later, not talk to your friends, cancel plans, all of those sorts of things that keep us well, and happy and able to manage and cope and deal with complaints, we tend to drop quite quickly. So I would say, keep an eye on the basics. Make sure you’re still looking after yourself, brushing your teeth, having your meals, you know, going to bed at normal time. And then talk with someone about it. Don’t keep it to yourself, because all of it, all of the bad stuff that comes with complaints gets worse if it’s left in silence or just in your own head. So yeah, reach out to somebody, whoever you feel you can trust at that time.

Jessica: Another thing to bear in mind is a bit like grief. It does eventually hurt a bit less. It will be preoccupying and painful for a while. But eventually, you will just move on and it will pass. And that was that, you know, I’ve had complaints, and you do recover even though it feels like you might not at the time.

Caroline: Yeah, naming that can be really helpful content just so when they, when I know when I get that email comes into my inbox, and you get that sinking feeling like oh, God, I’ve done something wrong. And the shame storm starts if I can just say to myself, oh, okay, I’ve been triggered here. I’m in my shame someone is going to be okay, I’m going to feel like this for a few hours, probably. But it will ease throughout the day. And it’ll probably feel a bit better tomorrow, and a week from now, and a year from now, I may not even remember it. I remember the feelings that when things like the emails drop in to my inbox, but I can’t remember about—

Rachel: —the health, there’s a phrase written in the main entrance of Addenbrooke’s, ‘It will pass, whatever it is’. And I think that it’s good to remember that, that it will pass. But Caroline, I just want to ask you, just thoughts about being really preoccupied with what’s going on at the time, and we can then stop to fixate on stuff and go into these recurrent shame storms. How do we stop ourselves from doing that? Is it possible to stop ourselves from doing that?

Caroline: So I think, no, I think we’re human beings. And I think we get triggered, shame gets triggered, and, and when it happens, it’s horrible. And we’ve all experienced it somewhere along the line. What I think we can do is being much kinder to ourselves when it happens, and not be with it and make it worse. So when I used to get complaints, sort of in my early years of my career, I would really wallow in them. I would beat myself up with them, I would stay you know, thinking about them not talking to other people. I would stop doing all the things that have helped keep me, kept me going and kept me well.

Now as I say when I get triggered, and it still happens every week or two at the moment, I’ll get something I think, oh, have I done something wrong there. I’m much kinder to myself about it. I’m like, oh, okay, oh, that’s made me feel a bit uneasy or a bit anxious or a bit, okay, well, what’s going to be nice, we’ll make let’s look at the rest of the day. How does the rest of day look? How can I take something off my plate, or who could I talk to? How soon can I do that?

And I start, so the way I relate to it changed. I think we can’t stop it from happening completely. I think we’re all going to get those intrusive thoughts that are unpleasant. And it is not nice when you know you have done something that has harmed another person that is deeply, deeply uncomfortable for us, particularly as doctors. So I think you’re not going to avoid feeling uncomfortable feelings and getting difficult thoughts, but it’s about when they happen, being really conscious of them. And looking after yourself in a way that reduces the intensity of them. And means they don’t last quite so long.

Jessica: Absolutely, Caroline. I think if we didn’t respond emotionally, we’d be psychopaths. But we certainly wouldn’t be doctors. But I think give yourself permission to say, you know what, I’ve had enough of the self-flagellation now I need to get on. I need to get on with my job. Yes, I screwed up, or maybe I got, you know, didn’t get something, didn’t do something as well as I should have done. But it’s time to move on now.

Caroline: Yeah, I find it easy. I find the thing that helps me is to remember that all the time I’m spending thinking about me, like, Oh, no, I’ve done this terrible thing, I’m such a bad doctor, is time I am not helping someone else. I’m not helping the next patient or not like raising my children. I’m not living my full life. Right. I’m just basically wasting time beating myself up. So I think, feel it, acknowledge it. And then yeah, gently move on. And if you’re finding that you can’t do that yourself, then get some help to do that.

Heidi: And although it sounds really trite, I would say to people, ‘Remember that you are not the first person who has ever had a complaint. You are not the last person who has ever had a complaint. This is part of being a doctor, and actually the CQC, or your employer or your trust or your appraiser, will find it very, very strange if you go through the entirety of your career, never ever receiving a complaint at all. It is part of life in clinical practice. And I think one of the important things that people can do is to recognise that this is a normal part of being a doctor.

Caroline: That’s reminded me of another great tip as well, which is when, if it’s your first complaint, try to pretend as if it’s your third or fourth complaint, as if you’ve already had two or three under your belt. You’ve got through them, you’re okay, you’ve learned from them. And actually, it kind of takes the sting out of that first one feeling like, oh, my God, the world’s gonna end. And that’s a tip I got from my midwife when I had my first child. You know, she said, ‘Just pretend this is your third child, and you’ve got another child over there running into the fire and another one in the other room screaming and you don’t have to give all your attention to this one thing.’ Same for a complaint, you know, it doesn’t have to take over your life. It can just be a part of what is going on for you at the moment.

Rachel: Yeah, I think just remembering that it is part of your job. It is part of being a doctor or a healthcare professional, that you will get people that are not happy with outcomes and weird things that have happened. And if we start to see it as our professional responsibility to be able to deal with complaints, and it’s like, oh, yeah, there’s that bit of a job that’s come here, even though you’re completely, we all completely dread it because no one likes to be criticised or, or supported or to do things wrong.

So I’m just wondering, is there any other sort of quick tips, practical advice you give to people when they are going through this, there’s already talks about trying to get some control back, you know, think about what you can control, what’s out of your control. We talked about depersonalising stuff, trying to say the same as, there’s you this patient, and there’s the thing that’s happened and getting some perspective. We’ve talked about the importance of debriefing with people and talking to colleagues about it. We’ve talked about some self-care and when, that the importance of maybe trying not to wallow in it and just give those thoughts a lot of credence.

I guess one of the things I was thinking as well is, pay attention to your self-talk as well. What are you saying to yourself in your mind? Are you talking like you’re talking to your best friend? Because most of us aren’t, we talk to ourselves in a really dreadful way. We berate ourselves, we tell ourselves all the time. But actually, what would you say if you were talking to your best friend in that situation, then? Caroline, you mentioned getting some stuff off your plate. And just going down to the basics of self care. What do I need right now? Am I looking after myself? And Jess said, if you need to, that might include taking some time off work, taking some, taking the time that you need? If you’ve got any other tips and advice, Jess, what about you?

Jessica: Just in terms of prevention, or controlling the controllables, if you are in a sort of pattern of getting, you know, a number of complaints, do think about what else you’re trying to achieve that time, whether it’s lots of childcare responsibilities, or working too many surgeries, or maybe you need to make your appointments a bit longer. And I’ve talked about this before, but there’s an acronym of halt H-A-L-T, which stands for hungry, angry, late, tired. Those, I think the defence organisations have probably recognised or make complaints more likely to happen. So if you can do anything to avoid those particular circumstances, that would probably be sensible.

Rachel: I think he also just that halt thing, probably when you’re going through a complaint, it probably seems a little worse if you’re hungry, angry, lonely, or tired as well. So if you’re ruminating on stuff, maybe just go and have a snack or all you know, calm yourself down and think, ‘Right, I’ll worry about this another time’. But at the moment, it probably is amplified because it’s in the middle of the night or I’m just tired or I’m knackered either. No, Caroline, would you say that to people?

Caroline: Yeah, I use halt all the time, although instead of late, I’ll use lonely. And I think for me, it would fit here in terms of not carrying the burden of the complaint on your own, but getting the professional support from someone like Heidi, or from someone like myself with your mental health or from a colleague.

Rachel: And what sorts of other things do you recommend, Caroline?

Caroline: I think when you’re in the middle of it, I think what we need, what I need, when I’m in the middle of a complaint, is somebody to tell me it’s going to be okay. You know, it’s going to be alright. We will get through this. Well, however bad my head is telling me it’s going to be, it is going to be okay. So I think it’s just remembering those basic human needs, to feel, but we’re not a terrible person. This isn’t the end of the world, and there are things that can be done to help us through it.

Rachel: What about you, Heidi?

Heidi: From a very practical point of view, I’d say, don’t send out your first response to a complaint without having it checked, be that by an indemnity organisation or a trusted colleague. Don’t send out that first response. Because however factual and objective and neutral you think you are being, you probably aren’t in that first response. And by all means, let that first response be your outpouring of anger, and grief, and distress. And be subjective, and be all of the things that your indemnity organisation will then tell you know, don’t do that. Be all of those in your first response. But absolutely do not send it out, make sure any response you send out is checked First, get those objective eyes on it.

Caroline: That’s a fantastic bit of advice, Heidi, and I call it doing a no send. So you write a letter or an email, but you don’t write it in your email accounts you accidentally send it. You write it in something like Word or notebook or where you can just get it all out and say what you want to say. Use the bad language and the swear word and be unprofessional, if you want to be because it’s important to process and get those emotions out. But not to send that so do a no send, then pause and then respond. So the difference between reacting and responding.

Rachel: I think one of the things as well as don’t expect things to be done and dusted really, really quickly. We want that to happen for— I think I can’t be happy, I can’t get rid of my anxiety until it’s finished, until it’s resolved. Actually, it might get one— unfortunately, some of these go on for years, don’t they? And so that’s slightly—Is it right? So that’s probably a bit unrealistic.

Heidi: Yeah, I mean, some of them do go on for a long time. Some of them do end up having other organisations involved. If a patient isn’t happy with your response as a GP, they can escalate it to NHS England, who may then choose to investigate other aspects of your practice. Ultimately, it can end up with your GMC or other regulatory body. And the idea obviously, is with any complaint, to try and resolve it as swiftly as possible. But I think if people are aware that they can go on for a long time, I think, hopefully, they will be in a mentally in a better place to deal with all of this.

Caroline: I’ll often advise doctors to put a boundary around the time that they’re looking at the complaint. So rather than sort of dipping into it, thinking about it every single day, maybe putting aside some time to think about it on a particular day at a particular time, when you know that you’re going to be in a relatively good place. So maybe morning’s about a few or afternoons. But setting aside time and putting a boundary around it so that you can then put it away again, mentally speaking, or put it in a little box, put the lid on, and then get it back out again when you need to. But rather than carrying it with you the whole time.

Rachel: Yeah, that’s great advice. So time is very nearly up. I’d love to just ask for each of your your three, three top tips for, you’ve had the complaint, how you survive and look after yourself whilst that complaint is is going on? What are your three top tips? Caroline?

Caroline: Feel your feelings and vent them in healthy ways. Look at the basics of your self care. Things like your eating, sleeping, socialising, basic self care, and then don’t do it on your own. Share it with someone, talk with someone, get support.

Rachel: Thank you. Heidi?

Heidi: I think my tips are all very practical in nature. First of all, I would say contact your indemnity organisation. Even if you don’t think this is a very serious complaint. Even if you think you can manage this on your own. Contact them. It’s what they’re there for, and it’s what you’re paying us for. It’s what you’re paying us to do, so make use of that resource. The second thing I would say is offer an apology. I think we’ve already said this, but offer an apology even in those cases where you don’t think the complaint is justified. Because this is very likely to help resolve this as soon as possible. And the quicker the complaint is resolved, the quicker your stress will go away. And the third thing I would say is yes, by all means write that first response, vent your feelings, absolutely. But destroy any drafts of your complaint response. Do not leave them hanging around in the patient’s file somewhere, in the complaint file, on your computer. Once you’ve sent the final response, store that final response and delete any other drafts so they cannot accidentally come to light at another time.

Rachel: That’s great. That’s very good advice. And it just struck me that, I think sometimes we set off with complaints with the wrong objective in mind, we want to prove that we’re right, as opposed to resolve the complaints.

Heidi: Absolutely. Your purpose here is just to resolve the complaint to everybody’s satisfaction.

Rachel: Yeah, yeah. And then make sure you’ve learned from it and that it’s actually improved in practice and all that sort of stuff as well. Finally, Jess?

Jessica: I echo everything — not left with very many — I would say, remind yourself that dealing with complaints is part of your professional role. Try to look at it from the complainants perspective, as much as possible, it will actually make it easier to be easier on yourself if you can understand where they’re coming from, or try to. And lastly, I would say, just cut yourself a break. And as Caroline said, don’t waste too much time beating yourself up because it’s not helping anybody, either you or the person complaining against you. So just remember everything else that you need to get on with.

Rachel: Thank you. Brilliant advice. Finally, finally. Caroline, I just wanted to say if someone is really struggling with this sort of thing right now, where can they go for help?

Caroline: So if you’re struggling with a complaint, I would say there are lots of different areas you can go for help try and pick somewhere you feel comfortable and safe, you can go to a defence union, you could go to your GP, you could go to your colleagues and your professional network, and if you want some confidential by the mental health support, you could come to something like the NHS Practitioner Health Program. If you just search ‘practitioner health’ in Google, it will come up and you can self-refer for free and confidential support around your mental health.

Rachel: Right, thank you so much. Just encourage people to get a tribe around you, get your people around you as your little support crew who are going to cheer you on, check on you. Just make sure you’re doing all right and that you can talk to about it. So really important. Thank you so much guys for being on the podcast. So that’s been really fantastic. If people wanted to get in touch with you or find out more resources, how could they do that?

Heidi: I think if people are a member of a defence organisation, then they would be better placed getting in touch with their own defence organisation but people are always welcome to come to Medical Protection and ask if they need any advice.

Rachel: Jess?

Jessica: Feel free to follow me on Twitter. I’d love to hear from you. I’m @GPJess_Harland.

Rachel: Lovely, thank you, and Caroline?

Caroline: You can get hold of me through The Joyful Doctor, www.joyfuldoctor.com or across all of social media as The Joyful Doctor.

Rachel: Right. And you can obviously see the rest of the podcast episodes and lots of other things that particularly Caroline and I have done around coping with COVID and mental health for doctors and things like that on the You are Not a Frog podcast website. So thank you so much everyone for being with us, and speak again soon. Thank you. Bye.

Thanks for listening. If you’ve enjoyed this episode, then please share it with your friends and colleagues. Please subscribe to my You are Not a Frog email list and subscribe to the podcast. And if you have enjoyed it then please leave me a rating wherever you listen to your podcasts. So keep well, everyone. You’re doing a great job. You got this.