In a new series Dr Ed Pooley, GP and communication expert, shares his knowledge with readers having difficulties with colleagues and patients in the workplace. In this first instalment, he tackles the age-old question – what do you do when threatened with a complaint?
Dear Dr Pooley
How should I respond if a patient says, ‘If you don’t give me what I want, I’ll be making a complaint!’
Dr Lindsey Kent
This type of interaction can be summarised as ‘if you don’t do <x>, then I’ll do <y>.’ It has the aim of putting pressure on you as the clinician to respond in a way that the patient feels is appropriate. The implications of this message are: ‘it is easier to do what I want than to deal with the consequences of not doing what I want’, and therefore ‘if you give me what I want then I’ll remove the threat’.
Common threats faced by GPs are: ‘I’ll complain or report you’; ‘I’ll do something that will put me in danger (for example, if you don’t give me a prescription for diazepam, I’ll get this from a drug dealer); or ‘If I get sicker, it’ll be because of you’. Perhaps the most challenging version of this would be ‘If my child doesn’t get seen, they will come to harm and that’s on you!’
Each of these interactions has the potential to leave us feeling frustrated and powerless: our medical opinion discarded or our following of guidelines detrimental. The best way to approach situations with the threat of complaints is to take the heat out of them. This can be done by:
- Acknowledging your responsibility is to provide medical advice and expertise, even if that runs counter to a patient’s expectation.
- Recognising that the threat is the patient’s responsibility to own, not ours.
- Being empathetic, and connecting the patient’s desperation for an outcome has led to an attempt to manipulate.
Depending on the nature of the threat, here are some useful phrases to deploy:
- ‘I can feel your frustration about this issue – I can’t, however, change my opinion based on a threat.’
- ‘I have made an assessment based on the information I have – if you would like to complain, that is your right.’
- ‘If you decide to do that, that is your choice’ (needs to be said in a very ‘neutral’ tone of voice).
- ‘Unfortunately, I have no power to influence other parts of the health system to do what you are asking, and I feel equally frustrated by this. Let’s look at what options might be possible if things change…’
- ‘I’m not able to give you my honest opinion if you are threatening me.’
- ‘I have to make an assessment on how things are now… if things change, we can reassess things to ensure that I’m giving you the most appropriate advice, even if it feels that it’s not what will help right now.’
Recognising manipulation is key to being able to deal with it. We are primed to recognise it when it is overt, but in fact we tend to encounter it more in its covert form – such as secondary care requests to ‘think of the patient’, flattery, or even flirtation. Each of these more covert approaches need to be managed similarly, as outlined above.
As with all threats, there is the potential for escalation. So, it may be necessary to deploy deescalation strategies such as: further acknowledgement; matching rapport; and highlighting that this is a consensus issue within the practice (it is helpful to have practice policies that can be referenced for common situations where there is conflict).
Above all, the nature of general practice is relational. We build relationships over time; each contact is an opportunity to build and strengthen the relationship between doctor and patient through building trust and continuity. By building the relationship, threats can be managed more successfully; if there is a frequently encountered scenario, ensure that practice colleagues are aware of the issue so that policies and strategies can be developed which present a united front and avoid discrepancies.
Yours in solidarity,
Ed
Dr Ed Pooley is a GP with expertise in time management, patient communication, and managing ‘difficult conversations’. He is the author of Managing Time in Medicine: Developing Efficient Consulting in Primary Care
NHS England , PCN or ICB threat – if you don’t do this that we are imposing – we will do this to you, your contract or your practice so it is better you do as you are being forced !
Odd this, I find it quite unrealistic. I’ve handled complaints for 25 years of GP for whichever practice I’ve been with. Almost never have I had to deal with the threat of complaint if a doctor does Not do what is wanted prospectively. It’s almost always about an act of omission or commission already done. And 95% are about access or process, or communications poorly handled.