Patient complaints and the response arc



One of the painful duties that accompanies consultancy or general practice is that of responding to complaints. However good you are, or think you are, the huge numbers of patients that you see mean that complaints are inevitable. How doctors and nurses react to them is very important – both internally and externally. Their parent organisations must also respond, recognise patterns or extremes, and make changes where appropriate. But at the level of the individual, for all the important or ultimately constructive comments that these letters and emails contain, they are by their very nature critical. Criticisms will usually be directed at individuals, because care is delivered by individuals, and each must learn how to absorb the negativity and process the message such that something positive results. This is not easy, and I believe doctors or nurses who receive a complaint experience a dynamic reaction, the first phase of which involves anger and annoyance. This article describes one such arc, and interposes the thoughts of a fictional patient. The 68 year old lady, of extremely sound mind, was not informed that she was being discharged by her team, and was then left waiting for hours in a discharge lounge. Her consultant is required to respond.


Not another one

Yes, I remember the name. She didn’t look happy when I walked past her on the day she left, something to do with not being informed, or transport delays, something. But we did a pretty good job, got her better

Come on!

“Is it worth writing this? I survived didn’t I?

But it was terrible, the way they left me…”

Oh, that’s trivial…it made no difference to her outcome…

The medicine was fine…this is nothing to do with me

I mean, I come into the office, open my emails, and what do I get – this! Just because my name was over the bed, it lands in my in-box.

“Nobody arranged transport. Nobody told me anything.

They were desperate for the bed, I could tell…”

I can’t be responsible for every little thing.

“But I’m going to. They need to know. A weaker patient,

a frail little thing, could have caught their death of cold…”

Well, I’ll write a response, but I’m not going to apologise

“I can see him now, the consultant. He won’t want to take any

of the blame. But they were his nurses…”

I don’t control staffing levels on the wards, I’ve got to focus on the hard stuff, the diagnosis, the treatment

“I’d say to him – don’t you see, you represent the whole system?

You were in charge of my care, and when I was ignored on the

ward, when I was suddenly discharged and left waiting for transport

for 4 hours in a drafty discharge lounge, I thought of you…”

Do I wake up in the morning and make a decision to deliver poor care? No! I do the best that I can in a pressurised NHS, an austere system…it’s incredible that we do as well as we do. So I’m not going to take this to heart.

“But it’s not about you, as such. It’s about fixing your hospital.”

OK…got to engage with this. Got to put down something constructive. It was a pretty rough experience by the sounds of it. I had no idea. Invisible to me, all that stuff, once I leave the ward.

“…and if it was your mother?”

Strange, really, I would have no idea this sort of thing happens if she hadn’t written.

“Imagine then, how many don’t write.”

When’s the last time I complained about anything? What does it take? A lot! This lady must have been incensed, to get home, to remember, to actually make the effort. Whenever I feel like complaining about anything it wears off after a couple of weeks. Can’t be bothered.

…20 minutes later

Good. Done. Hardly a defence union issue! But I’ll go have a word with the ward manager…let them know it spoilt what was otherwise a pretty efficient and successful patient journey…what’s the point of me and my team getting all the medicine right if the patients feel abandoned when they’ve recovered? Makes the whole system looks bad.

“Well I’m pleased. It’s almost as though we’re talking!

Such a shame we didn’t talk at the time.

None of this would have been necessary, I’m sure.”

Yes…I remember her better know, she was a lively lady. Perhaps I will apologise after all. Costs nothing


The key to accessing something positive, it seems to me, is the ability to exercise empathy over paper. One only needs to imagine how reluctant most of us are to complain about poor service in other walks of life. This is combined with a natural tendency to feel less angry with each passing day, when one has ‘escaped’ the situation that was so painful. If pen is put to paper, the intensity of dissatisfaction must indeed be considerable. And just as our role in any particular patient’s poor experience is likely to represent a failure of the system rather than personal error, the letters that we receive are likely to be addressed to the system as a whole, rather than the individual named. The name may just be a representative symbol, and as such, perhaps we shouldn’t allow the criticisms within to rile us too much. Less annoyance, more understanding – easy to say, not so easy to enact.



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