Complaints and the over-stretching of the doctor-patient bond

Patients who want respect, kindness, and competence must understand that the doctor has human limitations.

On the hottest and sunniest weekend of the year, I spent over five hours writing a summary of my interactions with a patient over the past 18 months. These five hours resulted in a 7,500- word report; the equivalent of two or three short stories or one-tenth of a novel.

Only it was not immersive writing, not the type where you lose yourself, enter that flow state described by Csikszentmihalyi (pronounced Cheeks-sent-me-high), where you lose all sense of time and self. When hours feel like seconds and you emerge from the creative project feeling refreshed, energised, and serene.

No, this was the antithesis of a creative process, as I painfully hammered out every word while chewing my way through innumerable bags of jellies, (a childhood comfort food), stopping only to get rid of the evidence by throwing the empty packets in the bin.

My creation gradually took the shape of a prosaic chronological report of repeated consultations detailing what I said, what they said, what I prescribed, how much, and why. There was no flow or literary merit and my conscious brain remained alert, screaming throughout that there was no point. 

A non-specific written complaint suggesting poor medical performance left me with no choice but to revert to my practice complaints procedure. I followed the protocol and requested medico-legal advice before responding to the complainant.

The advice I received cost me one of the warmest, sunniest days of the year. But the alternatives – to ignore the complaint or respond in haste – were not options. I am a professional trained in communication skills. I have spent years teaching communication skills.

Our business has had a complaints procedure for years with little cause to put it into action despite thousands of consultations and patient interactions. Like most GP practices, patient grievances are dealt with calmly and swiftly, to the satisfaction of both doctor and patient, without the need to seek medico-legal advice. 

Sometimes these actions have led to improvements in the service. More often, they have facilitated reconciling expectations of patients and doctors or staff members and strengthening the inter-personal relationships. Occasionally, patients have decided that the practice did not meet their expectations and have moved elsewhere. 

The use of email has improved doctor-patient communication, but it has also made written complaints easier. In five or 10 minutes a patient can write and send an email asserting poor medical care with no regard for the consequences for the doctor. Verbal complaints are relatively easy to deal with. The patient can be taken to a quiet part of the building and have the benefit of face-to-face communication. Follow-up can be arranged if necessary.

An email complaint cannot. Written in a moment of anger or frustration the sender will never witness the effect of this action on the recipient. A patient may perceive that they were dismissed, short-changed, or disrespected. They may have other stressful events in their lives. The doctor may have triggered a negative emotion by evoking a memory of a didactic father, a dismissive mother, or an abusive sibling. 

Sitting at the kitchen table with the sun glaring through the window, my husband happily engrossed in the Sunday matches, I had my own share of negative emotions that I tried to ignore, but could not. I felt no empathy for this person who was stealing precious hours of my weekend.

This person who was unaware of the consequences of their action. Why did I have to justify myself when I had done nothing wrong? Was I not allowed to express irritation and simply tell this person where to go? 

Even as I thought it, I knew I would never behave in such a way. But the price of always being professional and not speaking one’s mind is high. People can expect only so much empathy and tolerance from one person. Patients who want to be treated with respect, kindness, and competence must understand that the doctor has human limitations.

Professionalism and all that it constitutes takes effort and energy. Abusive and passive-aggressive written communication may be convenient for the complainant, but there are inevitable negative consequences. The doctor-patient relationship is not immutable. Like an over-stretched elastic band, it can become fatigued, break, and outlive its usefulness to the doctor and patient. 

It is desirable that patients consider how they treat their doctor if they want to receive the best possible medical care. Doctors do not have special powers and once a patient presses the send button, a doctor has no choice but to treat this seriously and engage with their complaints procedure, regardless of how trivial or inconsequential the doctor thinks it is.

Self-restraint, willpower, and the continued effort to understand the perspective of another, are limited resources and like time, we need to be allowed to spend these wisely.