What should you expect from your doctor?

03 Nov

We are all aware of the escalating complaints against doctors and read regularly stories of poor treatment. I always feel concerned when I read these articles as when a person develops an illness or medical problem and have to seek medical advise it creates an added anxiety as to whether they are going to receive good treatment or if they are going to be taken seriously.
The number of complaints to the General Medical Council(GMC) – which oversees doctors practising medicine in the UK – increased by 23% from 7,153 in 2010 to 8,781 in 2011 – continuing a pattern which has been rising since 2007.
About two thirds of these complaints are from the general public the remainder are from other public bodies such as the police or coroner services and others healthcare professionals.

However, although there is an increase in complaints it is important to put the figures into context. It is estimated that there are over 100 million patient-doctor interactions each year in the NHS. This ‘complaint-rate’ of less than 0.001% per interaction is something of which most industries would be envious.
Also, as the GMC points out, the rise in complaints may not be due to worsening services, but could be the result of rising patient expectations and an increased willingness to complain.

Nevertheless, we would all like to think that there were no complaints and it is not helpful to hear these figures if you have a serious complaint to make but I thought this would be somewhat reassuring to those who may be having to face medical treatment in the near or distant future.

What are the commonest complaints?

  • concerns with investigations and treatment, such as failure to diagnose or prescribing inappropriate medications
  • problems with communication – such as not providing appropriate information or not responding to people’s concerns
  • perceived lack of respect for the patient – such as being rude or dishonest

Many members of the general public are probably not aware that we are now appraised on an annual basis and every doctor since 2012 will have to go through a revalidation process every 5 years. The appraisal has to show that we are maintaining an up to date portfolio of attendances at educational meetings and literature we have read. We have to discuss how we communicate with our patients, our practise staff and medical colleagues and any complaints we have had and how we have addressed them as well as any accolades we have received. We have produce written proof that all these aspects are being addressed.

In this practise, for more than 10 years we have had a range of medical students assigned to the practise and I am always grateful to patients who are prepared to see them. When they start I am very anxious that they simply get used to talking to all ages and different types of people and learn to extract information in a respectful but effective manner.
I took a group of students to see one of our rather garrulous patients who albeit had a fascinating medical history. One delightful student, a highly intellectual Oxford Graduate in philosophy, who had decided to change tack and study medicine was asked to take this lady’s history. He was amazingly patient and an excellent listener and I decided to not interrupt for about 20minutes. Then I asked him to finish and we thanked the patient and left. When we as a group analysed what information he had extracted it was evident that he had extracted the smoking history of every member of  her family going back two generations and what had happened to them but we weren’t quite sure whether she had ever smoked. We had established how long she had been living in the flat, the price and the prices over the years and who had lived there before including a lady who had put her head in the gas oven and that’s why there was an electric cooker but not much more despite her having numerous medical problems.

I then said to him, “Suppose she then collapsed and you had to report to your senior colleague her main medical problems what would you say?” He then realised his gentle,caring listening manner had been his downfall.

As a group we all learnt from this as to how to focus a patient to get the correct information. As a group we worked with that student who eventually was able to use his listening talent effectively but also extract the relevant information teaching us all important lessons in history taking.
I often ask patients to write down all their concerns in a list to be discussed. This is also useful when attending hospital appointments.

Communication is a dialogue between two people and also involves interpretation of facts obtained.

When I was in practise in Wales patients would frequently report having had a “pull” and this could mean absolutely anything from pain of any sort to collapsing and as it involved careful questioning as well as close observation of the patient’s body language and knowledge of something about them to find out what they meant. Moreover, I soon learnt never to ask what brought them to the doctor to avoid the ramifications of the mode of transport that was or may have been available of ask how they were because the reply could be anything and often not medical!

We all know how difficult it can be to get anything but a grunt from a teenager and in one consultation I had to resort to asking a grunting 14year old boy to tell me what football team he supported and as he said “Chelsea” I flashed an Arsenal key ring in front of him and then words fell out of his mouth.

I have to say that in some parts of the country for example the’ Black Country’ (West Midlands)’ where some of my family come from it is impossible to understand what they are trying to say. As my mother would have said , ” don’t they have a broad accent?”

The Daily Mail were totally misguided when they implied that the communication problem was due to foreign doctors as figures do not support this and after all I was a GP in a Welsh speaking part of Wales!

Surgeons can be particularly poor at communicating as they are ‘doers’ and I have known brilliant surgeons who have weak communication skills. If I am aware a patient is going to have surgery or a procedure I often suggest that if they don’t get or understand the answers or explanations they need or want they can be seen by the GP to get this information. We can phone, email or write to or even meet the consultant face to face to get that information. They are more often than not charming and only too glad for us to liaise with them.

When it comes to rudeness or lack of respect, in the same way patients should not be rude of disrespectful then there should be zero tolerance for a doctor to behave in this manner.

imageThe GMC lays out very clearly the duties expected of doctors and I have reproduced this from literature which is sent annually to every doctor registered with them:-

Duties of a Doctor

The duties of a doctor registered with the General Medical Council
Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and make sure your practice meets the standards expected of you in four domains.

Knowledge, skills and performance

  • Make the care of your patient your first concern.
  • Provide a good standard of practice and care.
  • Keep your professional knowledge and skills up to date.
  • Recognise and work within the limits of your competence.

Safety and quality

  • Take prompt action if you think that patient safety,dignity or comfort is being compromised.
  • Protect and promote the health of patients and the public.

Communication, partnership and teamwork

  • Treat patients as individuals and respect their dignity.
  • Treat patients politely and considerately.
  • Respect patients’ right to confidentiality.
  • Work in partnership with patients.
  • Listen to, and respond to, their concerns and preferences.
  • Give patients the information they want or need in a way they can understand.
  • Respect patients’ right to reach decisions with you about their treatment and care.
  • Support patients in caring for themselves to improve and maintain their health.
  • Work with colleagues in the ways that best serve patients’ interests.

Maintaining trust

  • Be honest and open and act with integrity.
  • Never discriminate unfairly against patients or colleagues.
  • Never abuse your patients’ trust in you or the public’s trust in the profession.
  • You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.

I have to say for the most part I find my fellow doctors fulfil these duties honourably and I am proud to be part of the medical profession.
We are all patients and I trust that we all do our part to be as helpful in providing relevant information, cooperating appropriately and working with them to manage our medical problems.

If you do have a complaint please address them to the practise manager or PALS – the complaints procedure is on the website.


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