Terence Stephenson: Doctors shouldn’t fear patient feedback

We need to make feedback meaningful for doctors and easier for patients

Everyone likes to be congratulated on a job well done especially if you have helped a patient who has put their trust in you as a doctor.

Of course the best praise comes unprompted, as asking how well you’ve done, perhaps with an expectant smile on your face, always seems a little too needy.

And what if you’re then told how you could be better at doing the job you’ve been doing your entire working life? It might be an opportunity to learn a little and to improve, but at the same time it can make you very uncomfortable.

As a working paediatrician, and one who is preparing for revalidation for the second time, I am going to be seeking feedback from patients as well as colleagues.

My experience is that the feedback I get from patients and carers is good. It’s very flattering, but I sometimes wonder about its value.

In an age when where even the slightest of imagined failings might lead to a one-star rating on Trip Advisor or Amazon, am I worthy of good reviews almost all of the time?

Of course it’s possible that some doctors might try to “game” the system, by deliberately withholding feedback forms from patients when consultations have been challenging or difficult. But those are often the situations where even experienced doctors like me can learn valuable lessons.

The doctor patient relationship is an interesting one and varies depending on the type of doctor as much as the type of patient. GPs, for example, might have to refuse patients who demand antibiotics, while a psychiatrist might have to explain why increasing a patient’s medication is not in their best interests.

That may not result in satisfied patients, depending on their prior expectations or hopes of a quick cure, and the likelihood of having to discuss sensitive and personal issues only adds to the potential for conflict.

But negative feedback is unusual. Most patients are happy to respond to a request for feedback with glowing endorsements. Why?

Maybe patients are just happy to be seen by a medical professional in a hard-pressed NHS. If he or she has a name badge and a stethoscope then perhaps the perception is this is someone who can help and if you’re someone in need of that help then you’re likely to be very grateful.

A lot of patients remain deferential to doctors. They may not doff their caps when we pass, but I think they’re unlikely to be critical of dealings with us unless they have a specific grudge or grievance.

And although feedback is of course anonymous, there’s still some way to go convince everyone of that. My late mother-in-law had an unfounded, but genuine, concern that any adverse comments might affect her future care. She wasn’t alone in having that belief.

So with most feedback being positive, whatever the reasons, how much value is there in spending a lot of time and effort soliciting, collating, thinking about, and presenting the views of patients and their families?

Already hard-pressed admin staff, receptionists, or nurses have to spend time helping make all this happen, amid cynicism from those who believe it will have little bearing on appraisal practice.

But as feedback increasingly becomes the norm, there is a role for all of us to talk to patients about feedback they can give us, about how it can help us as doctors, and how it can ultimately help improve the care they and fellow patients receive.

Research by UMbRELLA—commissioned by the General Medical Council (GMC) to conduct a study into the impacts of revalidation—showed that, where patients submitted feedback, a majority of doctors found it to be the most helpful type of supporting information to help them reflect on their practice. Patients should be reassured that what they tell us does not disappear into a void.

While it’s usually older patients who are more likely to be deferential (though not always), younger generations expect to be able to give their feedback, be it good or bad, and where appropriate for it to be acted on.

So for now it may be a case of reflecting with that in mind. Is a series of glowing endorsements reason to sit back and change nothing or are there hints within them that I could become a better doctor?

Equally, is a bad review something to avoid at all costs or in context does it contain even a little something that can I can use to my advantage and to that of my patients?

Patient feedback is here to stay, and the GMC has committed to reviewing its requirements to make it more meaningful for doctors and easier for patients.

Over time doctors might find they receive feedback whether or not it’s asked for. But we shouldn’t fear it; it’s a great opportunity to see ourselves through the eyes of others. A patient’s view of your work as a doctor can give you an interesting and valuable perspective.

Terence Stephenson, Chair of the General Medical Council.

Competing interests: None declared.