Complaints have very little to do with the doctor’s competence

Joseph Bulmer

I’m not sure how it happened and I’m not Welsh but during my career I was appointed by the Welsh National Assembly as an independent reviewer into complaints.

Complaints in any job are difficult. Some are spurious and appear completely unreasonable, with others we look at ourselves and admit that, maybe we could have done better.

The National Assembly for Wales morphed into the Welsh Parliament and is now the Senedd. And the complaints system has also moved on.

When I was appointed, complaints took two stages.

When the Health Board received a complaint, a lay chairman was appointed who asked two independent GP to write a report.

At this stage I read the paperwork and explained whether I thought it needed further investigation.

I never saw the other GP’s report. The lay chairman would read both reports and decide.

If there appeared to be a case the lay chairman called a meeting.

These involved several people from the NHS and two different independent GPs.

We would then interview the person making the complaint, GP and any other witnesses.

If called to a meeting, I would not see the reports from other independent GPs but was sent all the other paperwork.

It was fascinating to see how often my impression from the paperwork was changed by the meeting.

This was not a court of law. There was no 'guilty' verdict but if we agreed with the complaint or found anything else that worried us, the doctor was 'found to be in breach of his or her terms of service' and fined.

And it didn’t stop the doctor being sued.

So, what did I learn?

Complaints have very little to do with the doctor’s competence.

The mass murderer Dr Harold Shipman never received a complaint and was popular with his patients.

Most GPs will receive the occasional complaint throughout a 30-year career but doctors who receive numerous complaints may have a problem with their 'bedside manner'.

If patients love their GP, they can be forgiving or not even realise that the care could have been improved.

There are also 'serial complainers'. Someone who makes numerous complaints about their GP may well also be complaining about restaurants, shops and other services.

Some unreasonable complaints were tragic.

In one case, an adult with severe learning difficulties, who lived with his parents, was admitted to hospital, discharged and tragically died at home over a weekend.

The parents complained about their GP.

The parents argued that he knew their son really well and should have rung the hospital to insist he was not discharged.

He had not been on duty and only heard about this tragedy when he came back to work on the Monday.

Even if he had known, GPs do not have the power to tell a hospital not to discharge a patient.

These parents needed help and support with their bereavement.

Sometimes the problem was the handling of the complaint.

In another case, someone had written a reasonable letter to the GP asking him to explain his treatment.

It was not a complaint but he received a letter from the practice manager simply explaining what a wonderful practice they were.

He wrote again, addressed to the GP, and received another reply from the manager explaining that he could not answer the question as he was not a doctor.

Reading the series of letters I could feel the patient becoming more angry until he finally put in a formal complaint. I could sympathise.

We called a meeting, took evidence from everyone, and found the doctor in breach ('guilty').

Had he answered his questions in the first letter courteously it would never have ended in a complaint.

Sometimes the doctor may well have carried out a proper examination but did not write it down. If it is not in the notes, we assumed it didn’t happen.

Looking at complaints into other GPs made me look at my own practice.

Did I make good notes, did we listen to patients’ complaints and concerns, how was my 'bedside manner'?

The only part of the meetings which did not help me was when they started speaking Welsh.