Complaints Complaints Reason

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					Complaints
     Reason for Complaints
Failure in delay/wrong Diagnosis     30%
Attitude or rudeness of doctor       14%
Inadequate/inappropriate treatment 11%
Other                                10%
Failure/delay to visit                 8%
Failure to perform or poor examination
  5%
Failure/delay/inappropriate
  5%
    Complaints

NHS Complaints process
     Local resolution
  Healthcare Commission
       Ombudsman
      Why do complaints occur?
•   Error
•   Grief
•   Poor understanding/poor explanation
•   Unrealistic expectations
•   Failure to appreciate needs/wishes of
    patient
    How to answer complaints
Look at the complaint letter, clinical note and
   response.
1. Consider how you would answer it?
2. What do you think of the response?
3. How could it be improved?
                     Response
• Aim
   – Resolve concerns
   – Not about who’s right and who’s wrong
• Factual content
   –   Chronology
   –   Findings
   –   Actions
   –   Reasoning
   –   Correct
• Tone
   – Non-confrontational
   – Sympathetic
   – Non-defensive
• Answer questions raised
The complainant is
usually far worse off
  than the doctor
Communication
GMC - Good Medical Practice
          2006
Good Medical Practice (2006)
31 Patients who complain about the care or
  treatment they have received have a right
  to expect a prompt, open, constructive and
  honest response including an explanation
  and, if appropriate, an apology. You must
  not allow a patient’s complaint to affect
  adversely the care or treatment you
  provide or arrange.
     Healthcare Commission
• Complaint
• Manner in which it was handled
• Option to undertake Independent review
               Ombudsman
•   Statement
•   Interview
•   Can compel individuals to attend
•   Recommendations
•   Teeth!
Clinical Negligence
           Clinical Negligence
• Claims
• Sued
• Litigation
      Why do people sue:

– to understand the facts
– for an apology
– to stop it happening again
– to get an independent explanation
– MONEY
                GP Claims
• Medical errors      26%
• Failure to diagnose - surgical        21%
  appendicitis, torsion of testis, fracture
• Failure to diagnose - medical         13%
  meningitis, malaria, diabetes
• Management of pregnancy &             13%
  labour
Civil Negligence
          • Duty of care
          • Breach of duty
          • Causation
           Breach of duty
• Bolam test
• Guidelines and protocols
      Bolam vs Friern Hospital
    Management Committee[1957]
“A doctor is not guilty of negligence if he has
 acted in accordance with a practice accepted
 as proper by a responsible body of medical
 men skilled in that particular art
           …a doctor is not negligent if he is acting in accordance
            with such a practice, merely because there is a body of
            opinion taking a contrary view.”

                                                 McNair, J
       Breach of duty- Bolitho
     Bolitho vs City and Hackney Health
              Authority[1997]

“If in a rare case it can be demonstrated that
  the professional opinion is not capable of
  withstanding logical analysis, the judge is
  entitled to hold that the body of opinion is
  not reasonable or responsible”
              Causation
• Barnett v Chelsea and Kensington
  Hospital (1969)
• Chester v Afshar (2004)
How to avoid trouble
       Areas for Good Practice
•   Communication
•   Prescribing
•   Medical records
•   Training
•   Equipment
•   Guidelines/Professional responsibilities
Communication
      Communication Skills
• Most complainants and claimants mention
  communication as a problem
• Most health professionals think they
  communicate effectively
  Communication Skills
“Before explanation and advice can be
given to a patient, three diagnoses
must be made - the diagnosis of the
disease, the concept or fears of the
disease in the mind of the patient, and
of the patient’s capacity to understand
the explanation.”
C M Fletcher
Communication in Medicine
           Communication
More than 50% of 263 patients who sued
 their doctor claimed that they were so
 turned off by the doctor that they wanted
 to sue him/her before the alleged event
 occurred.
 Mangels
    Med Econ 1991
            Communication
“He was a cocky b… When my
  “hypochondria’’ turned out to be a pituitary
  problem, I couldn’t wait to haul him into
  court”

				
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