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‘Your hospital stinks,’ the letter begins.
My heart sinks. It doesn’t matter how many ‘thank you’ cards you receive, it is the complaint letter on which you ruminate, searing every detail to memory.
It doesn’t refer to me by name, but the somewhat derogatory description which follows is, unmistakeably, about me.
I remember him well. A 50-something-year-old man, admitted with an ST segment elevation myocardial infarction and sent down from the cardiac ward for a routine surveillance gastroscopy.
The decision was a no brainer. ‘Performing this procedure so soon after your heart attack isn’t safe, it could precipitate a further heart attack,’ I informed him.
‘We will rebook you in for six weeks’ time.’
He had been angry – it wasn’t convenient for him to return on another occasion. He lived 20 miles away, there were no direct buses and a taxi was too expensive. Despite my attempts to explain, I was left frustrated – he had not been listening to me.
First comes anger – I mentally devise a cutting reply. Next comes shame – I will have to share this with my consultant, and declare it on the ‘Form R’ at my next appraisal.
Everyone will know what a terrible doctor I am. I tentatively show a colleague the letter.
‘That’s nothing,’ he retorts – ‘last month I got one saying that I needed to go back to medical school.’
Similar words of condolence follow and I am briefly heartened by the ‘them-and-us’ camaraderie. I open the patient’s case notes. The facts are as I remember but a few details catch my attention. He is self-employed and cares for his sick wife.
After a few moments of reflection, I begin to understand him. The admission to hospital had probably come at a bad time as he was trying to balance caring responsibilities with providing for his family. Simply returning for this procedure at a later date was perhaps not quite as simple as I had presumed.
It seems it was I that had not been listening to him. Had I taken just a few moments to explore the apparent incongruity of his anger, he may have left feeling more understood and I might have avoided the hours of emotional turbulence for both of us.
Complaints are a fact of medical life that I will never get used to, but there is almost always something to be learned. If we can take the time for some open-minded, self-reflection we have the opportunity to improve our practice and speed the process of moving on.
Emily Claire Vincent is a gastroenterology registrar in the east of England. She writes under a pseudonym.
Here are two papers that perhaps give some insight on how complaints impact on doctors:
bmjopen.bmj.com/.../e006687.full and bmjopen.bmj.com/.../e011711.full
I too would have been upset at receiving a complaint like this as a junior, roll on a few years as a consultant it is water off a duck's back.
The appraisal will be OK so long as the number of complement letters exceeds that of the complaint letters.
Why are you trying to justify his behavior? You say he is the carer for his sick wife, what use is he to her if he were to die during the endoscopy?
As doctors we are required to offer patients the correct medical advice, even if it is inconvenient for them.
I would have felt the same few year's ago as you have felt now. Honest refection is important therefore I would not worry about some thing that has been written on your appraisal. However your appraisal is not in the public domain. It is important for all of us to check and reflect on our work. Include your compliments in your appraisal as well as difficult encounter like this. In a busy clinical situation it is not always possible to come just all the time. As a doctor it is important to realise that we are all human. It is important that we should think about the patient's safety first. Complying with the patient's request all the time attitude could cause more harm than good. You will be more liable to the complications resulting for the decision only when you have taken the decision outside the clinical context.
Well captured movement from anger to defence to compassion and to learning. That's one to include in a mature appraisal document. Complaints have taught me to apologise when needed, to stand firm when required, but always to listen and show that I have heard: unfortunately it can take more time than I can allow... And therein lies the rub.
I may not work in the medical field but I know how it feels when you get a complaint which relates directly to you. I remember in a previous job, a client wrote a complaint letter which made it clear that she was talking about me being a witness to a particular incident. My boss took me into her office to ask if I had indeed been on reception at the time and had I witnessed the incident as was being claimed by the client? I told her yes to both questions but explained that I didn't want to get my colleague in trouble. She informed me that I wouldn't, however she would suggest to my colleague that she make an apology to the client.