Along with advances in medical care, there has been a great shift in the expectations of patients - and their willingness to complain about any perceived shortfall in their care.
The number of complaints and claims has risen year on year, but this has not been shown to be associated with a reduction in the standard of care provided by doctors. While some complaints relate to actual shortfalls in medical care, many more arise from concerns about other non-clinical issues, or a perception by the patient that something went wrong, when in actual fact, from the clinician's perspective, the care was good.
So why do doctors and patients view the same situation so differently, and why is this important?
A different perspective
In the same way that two travellers on an aeroplane will reach the same destination at the same time, a doctor and their patient will travel the same journey together. However, their experience of the journey can be as different as if one travels first class and the other economy.
A clinician will tend to view successful care in terms of clinical outcomes, but patients are much more likely to place importance on other factors such as the emotional impact of the experience, and whether or not they feel cared about and cared for by the clinician.
Why might patients see things differently?
Too much information
With almost universal access to the internet, patients very often attend their doctor with a preconception of how they will treated, based on information from websites that may be inaccurate, or aimed at patients from other countries where the medical care may be different.
They may be expecting investigations or treatment currently unavailable in the UK or on the NHS. They might also base their expectations of the experiences of friends or relatives whose clinical scenario may have been different (such as expecting antibiotic treatment for a sore throat).
Lack of information
Patients may not have been appropriately informed about what to expect, and so could have unrealistic expectations about things like waiting times, private practice fees or complications of treatment.
Where a patient is seen by different clinicians for the same problem, without a proper understanding of medicine they may see uncertainty about diagnosis or treatment or different advice as indicating that one or more of their doctors has got it wrong.
Most patients will be anxious when they see a doctor and this can compound the factors above, and make misunderstandings more likely.
External factors that cannot always be avoided can contribute to the problem. Appointment times in the NHS make it difficult to spend enough time talking to a patient to check they fully understand the issues involved in their care, be this diagnostic uncertainty, complications of treatment, or different treatment options.
A complaint can come as a shock for a clinician when the care provided has technically been good. This is one good reason to try to avoid complaints, but it's also worth remembering that patients do not always just complain directly to those providing care. They may choose to involve other organisations such as the GMC, the Ombudsman, the coroner or the police. This can trigger investigations with potentially serious outcomes for the doctor.
A complaint can come as a shock for a clinician when the care provided has technically been good.
Minimising the risk, maximising patient satisfaction
Provide information in other ways
Good communication in consultations is important, but so is making information readily available in other ways. Provide clear information on your website, on answering machines, and posters in waiting rooms so patients know what to expect.
This is particularly useful to ensure patients know how long consultations are scheduled to last, how long they should allow for a prescription to be generated, opening times, fees for services and so on.
Communicate in a way the patient can understand
Every patient is different, and tailoring advice to the patient is a skill that most clinicians develop with years of experience. Some patients expect more information than others, and some will be able to understand technical information better than others. Try to avoid medical terminology, abbreviations and jargon, and with the patient's permission, involve those close to them in the discussion where possible.
Check understanding and allow the patient to ask questions
Depending on the seriousness of the discussion, patients may have difficulty absorbing what you say. A good way to check they have understood is to ask them to repeat what you said. Depending on the nature of the problem, you may wish to offer a further appointment to go through things again. Patient information leaflets or information about extra resources can be very helpful for the patient to read at home.
Show empathy and understanding.
Providing the best clinical care is the priority, but patients do appreciate an empathetic approach and the doctor's bedside manner is as relevant today as it was in years gone by. Establishing a good rapport and professional relationship with your patient goes a long way to gaining their trust, and as a consequence, improving their experience.
Be open to feedback from patients
A recent UK survey of patients revealed that 7% of respondents reported experiencing a potentially harmful preventable problem in primary care during the previous 12 months. These patients were eight times more likely to report that they had no confidence or trust in primary care.
However, only half (48%) of them discussed their concerns within primary care, the most common reasons given being unable to find the appropriate person, feeling uncomfortable about raising the concerns, or worrying that it would affect their future care.
Developing an informal, non-confrontational way for patients to discuss concerns or leave feedback may mean that you can address any issues in full, and hopefully avoid escalation to a formal complaint. You may also find the feedback helps you to make changes to improve patient confidence in the care you provide.
Patients and their doctors will always have different perspectives. This is unavoidable, but if you are aware of it, you can anticipate concerns and prevent them from arising, and as a result, improve your patients' confidence in the care you provide.
Providing informal opportunities for them to discuss their care also gives you the opportunity to reassure them, manage their expectations and build trust. You might find they are valuable resource for your practice.
Dr Beverley Ward
Beverley is a former GP and has been a medico-legal adviser at the MDU since 2008. She provides advice and assistance to members of all specialties on ethical and legal matters arising from their care of patients.
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