Jane Feinmann: Taking complaints seriously


I’m at my GP surgery on the point of becoming a nuisance patient—it seems I have all the qualifications.

Five years ago I was discharged from hospital after a medical mishap, serious enough to have my family gather at my bedside. I’ve tried and failed to get a full explanation of what went wrong. Now, with new complications, I have to see a specialist again—and I’m asking my GP to refer me to a consultant other than the one who was responsible for the medical mishap and who has proved to be unwilling to discuss it.

As I start to outline the medical mishap and its consequences, the atmosphere in the consulting room starts to cool. I’ve no plan to make a complaint about what happened to me, but I clearly have a grievance. And as the paper “Taking Complaints Seriously: using the patient safety lens,” published in BMJ Quality & Safety, says, that puts doctors on their guard.

Doctors dismiss dissatisfied patients as troublemakers, because complaints are so rare, according to authors, Thomas Gallagher and Kathleen Major from the University of Washington Medicine Center for Scholarship in Patient Care Quality. “Even for the most complaint prone providers, the number of complaints relative to the total number of patients seen is extremely small,” they write. These small numbers can easily be interpreted to mean “that the perceptions [of those who make complaints] are wrong and the complaints are attributable to the patient’s personality.”

Even health professionals who recognise that a small number of complaints signal a genuine problem can find it “difficult to identify underlying problems with confidence” as most patients on the receiving end of this problem appear to be managing perfectly well.

This response is dangerous, they say, contributing to unsafe care. “In complex medicine today, patients and family members are often the first to detect lapses in safety or quality, to identify worsening outcomes, or to point out breakdowns, in communication that providers have missed.”

But patients have to accept equal responsibility in failing to raise concerns about possible unsafe care. Someone like myself, happy and able to stand up for my rights in most areas of life, gets anxious at the prospect of their doctor seeing them as a nuisance. Hyper-aware of a doctor’s body language: a slightly raised eyebrow, a small shift of body weight that says loud and clear: “Here we go, another difficult patient,” the instinct is to zip it and re-join the throng of grateful patients, the ones that doctors like and look after. Yet my experience of persisting with my request has to be typical: my doctor may not have wanted to listen, but having heard the situation, he acted entirely appropriately, and I will get the care I need.

Currently, Health Education England’s Commission on Education and Training for Patient Safety, chaired by Professor Sir Norman Williams, is taking evidence on how to ensure that “patient safety is embedded in the heart of our staff and workforce culture“—and is due to report in November.

A priority must be to clarify this doctor/patient interaction identified by Gallagher and Mazor and state explicitly that good doctors don’t make judgments about people who make complaints. It’s equally important, however, to encourage patients to have the confidence to speak up in a consultation and seek their doctor’s help in managing examples of unsafe care.

Jane Feinmann is a freelance medical journalist  with a particular interest in patient safety based in London. She belongs to Imperial College Health Partners’ Patient Safety Champion Network.

Competing interests: The author has no competing interests to declare.