I’m at my GP surgery on the point of becoming a ‘nuisance’ patient. It’s been five years since I was discharged from hospital following a medical mishap - serious enough to have my family gather at my bedside. In that time, I’ve tried and failed to get a full explanation of what went wrong. Now with new complications, I have to see a specialist again - and I’m about to ask my GP to refer me to a consultant other than the one that was responsible for the medical mishap and who refuses to discuss it. And it’s tough going.
‘Oh really why is that?’ asks the GP when I ask to be referred to a different specialist - giving me what feels like a hard stare. |As I explain the details of the medical mishap and its consequences, the atmosphere starts to cool. I've no plan to make a complaint, I'm simply putting my request in its clinical context. But it's clear I have a grievance - and suddenly I feel judged.
It’s a common experience for patients - and one that’s actually dangerous, according to a paper in the BMJ Quality & Safety (April 2015), Taking Complaints Seriously: using the patient safety lens, http://bit.ly/1XBight. According to the authors, Dr Thomas Gallagher and Dr Kathleen Mazor, it’s normal practice for health practitioners to dismiss patients who complain as troublemakers. 'It's easy,’ they say, ‘to dismiss complaints as attributable to the patient’s personality; the fact that complaints are relatively rare contributes to this tendency to undervalue them’.
After all, even for ‘the most complaint-prone providers’… the number of complaints relative to the total number of patients seen is extremely small. ‘These small numbers can be interpreted to mean that the complainers are unusual and that their perceptions are wrong,’ say the researchers. Further, those health professionals who recognise that a small number of complaints signal a genuine problem can find it ‘difficult to identify underlying problems with confidence’ when most patients on the receiving end of this problem appear to be managing perfectly well.
Patients understand all this at some level. We’re hyper-aware of a doctor's body language: a slightly raised eyebrow, a small shift of body weight that says loud and clear: ‘Here we go. Another difficult patient!’ The self-monitoring risk-averse-scanner hard-wired into the brain goes into overdrive: the instinct is to zip it and re-join the throng of grateful patients, the ones that doctors like and look after. Unfortunately, this common interaction between doctor and patient is a major contributor to unsafe care, explain Gallagher and Mazor. ‘In complex medicine today, patients and family members are often the first to detect lapses in safety or quality, identify worsening outcomes or point out breakdowns in communication that providers have missed’.
Currently, Health Education England’s Commission on Education and Training for Patient Safety, chaired by Professor Sir Norman Williams, is taking evidence on how to ensure that ‘patient safety is embedded in the heart of our staff and workforce culture’: http://bit.ly/1JP3zgV - and is due to report in November. Perhaps a key step is to adjust this balance: find a way to give patients the confidence to speak out - and support doctors in becoming less prone to judging patients with a grievance.
My view on what counts in healthcare
Health risks of MedApps – How I helped MHRA to do its Job
How I helped to MHRA to police Health Apps If you Googled ‘skin cancer’ two weeks ago, you may have found a health app, Mole Detective, on Google Play that Read more…
Do we really need a reporters’ guide to rheumatoid arthritis?
As far as I know, RA is a disease with well-established therapy that is becoming increasingly uncommon – and am curious to know the rationale for paid-for publication in a Read more…
A way forward for quality peer review
July 31, 2014, BMJ
Blind faith that the publication of medical research in peer reviewed journals elevates a study to the status of “the evidence,” and therefore “the truth,” may be on the wane among those in the know. But for the public, and a vast number of doctors, this “naïve and misplaced” credulousness persists.
To read more: