Richard Smith: You have a duty to complain

Richard SmithHave you made a complaint recently? I don’t mean moaning to your partner about the weather or your neighbour’s barking dog but a written, formal complaint. If you haven’t you should—because we are relying on sharp elbowed, middle class people like you to keep up and even improve the performance of everything—the NHS, the BMA, Liverpool Football Team, the WHO, the BMJ, your local library, and the weather.

I’ve been meaning to write this blog for ages because I fear that complaining doesn’t get the attention and praise it deserves. “Disgusted of Tonbridge Wells” is a figure of fun not reverence.
My latest complaint—now an hour old—is to Royal Mail. I work from home and was pleased to discover that I could print postage from the Royal Mail website, so avoiding the long queues at the post office (must get round to complaining about that). It’s a horrible, unfriendly website, and I got off to a shaky start by discovering that with my usual browser, Google Chrome, I could pay for the postage but not print it. I complained about that and switched to using Internet Explorer. Things then went well until just before Christmas when the whole site went haywire. I didn’t complain then, but it’s now been down for about two months—and so I broke off from my work of global significance to make a complaint.

In my time I’ve complained to the NHS, British Airways, GNER (maybe if I’d complained more often and more loudly they’d still be in business), Lambeth Council, Virgin Media, and various food producers. As students we complained that we weren’t “completely satisfied” by Heinz tinned steamed puddings on the philosophical grounds that “complete satisfaction” was impossible and were sent two new tins. We also thought it hilarious to complain to a soup manufacturer that we’d found a crab’s claw in our tin of crab bisque when we’d actually got the claw in a Chinese meal. Again we were sent two tins.

My complaint to the NHS had to do with waiting two hours with my mother to have her hip checked after hip replacement, a check that when it eventually happened took just a minute or so. I tried to be positive and pointed out that many hospitals didn’t have such routine follow up, that it could be done by phone, and perhaps wasn’t necessary at all. After much confusion I did get a response from the consultant, saying that they would discuss my suggestion. Whether anything changed I don’t know, but I’d like to know. Perhaps I should complain that I wasn’t told the outcome.

We may be slow to complain because we think that we don’t want people complaining about us. We are brought up to see complaints as bad things, and it was one of the revelations of my life when—at about age 35—I first heard the idea that complaints are good things. “Every defect is a treasure” is one of the mantras of continuous quality improvement—because it provides a direct route to doing better. And for everybody who takes the trouble to write and complain there are probably 500 people thinking the same but who hadn’t complained in writing.

When I was the editor of the BMJ we thus assiduously collected, analysed, discussed, and responded to complaints. I can remember jogging on a beach and somebody telling me that “the BMJ is rubbish because it doesn’t publish enough randomised trials.” That complaint went into our collection. The commonest complaint we received was “the main trouble with the BMJ is that there’s too much of it. Can’t you close down for a few weeks and give us all a rest?”

Some editors thought it unbalanced that we collected complaints and not compliments, so we began to collect those to. But compliments are dangerous—because they are less likely to be true than complaints, encourage complacency, and don’t provide a clear way to improve.

So it is your civic duty to complain. See if you can manage three before the end of the week. Once you get started it’s easy.

RS was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.