And after all that, tea will need preparing, the bins need to be put outside and perhaps then I can go to bed. I will share another little excerpt today, one of the stresses of general practice. One that all GPs hate, the dreaded complaint.
And here is what happened prior to the complaint, the consultation with the patient who complained:
After Moira leaves, I spot another three ring backs arrived. I’m running more than a quarter of an hour behind and I need to catch up. The receptionists would alert me if anything urgent had popped up. I leave the ring backs for now and buzz for the next patient.
Immediately an instant message pops up on the screen from Elaine, “Be careful with this patient, Dr J. He was very agitated and verbally aggressive in the waiting area.”
Forty-three-year-old Darren walks in without knocking, his face like thunder, “This is absolutely ridiculous. Do you think I have all the time in the world? For me, time is money. If I take time off to see the doctor, I don’t get paid and I expect to be seen on time. The service you provide here is completely atrocious. This is unacceptable and I should go to my member of parliament over this.” Darren’s demeanour is such that images of cartoon characters with steam coming out of their ears come to mind.
No ‘hello’ or even giving me a chance to apologise first. No, Darren steamrolls his way into my room and airs his anger. He remained standing while he spoke, his posture aggressive and looming over me, an attempt to intimidate me further. Now he sits down, sliding down on the chair, his face still like thunder.
How can I save the situation? “I’m genuinely sorry to keep you waiting. You are absolutely right that it is unacceptable to keep you waiting for such a long time and I take full responsibility for that. I apologise sincerely.” I take a breath, “So what can I do for you today?” and hope my apology will calm him down a bit, the fact I agree it is unacceptable may take the wind from his sails.
“Well, I don’t really have the time for this, but now I’m here,” he takes out a piece of paper with writing on it. “First of all, I have an ingrowing toenail and want some antibiotics for that. Second, I have this nasty cough for the last week and need antibiotics to clear that. And the third problem is this rash on my leg that has been bothering me for a few weeks. It’s itchy and you need to do something about that.”
How should I deal with this? At the surgery, we maintain a simple rule, One appointment, One patient, One problem. Instead, Darren expects me to deal with three problems at the same time and I am already running late. Every problem deserves their own proper attention and trying to force three problems within one appointment may make this difficult.
I try to explain to Darren that we usually only allow one problem per appointment to allow it to get the attention it deserves, but I notice how he only gets more agitated and instead inform him we will deal with his problems today.
When I check his toenail, the nail is indeed growing in slightly, but it is not infected and does not require any treatment at the moment, “Daily bathing of the toe will help to avoid this getting infected. Just ten minutes in warm water and soaking it before dabbing it dry. If the toe does get infected after all, then please come back to have it checked.”
Darren sits up a little straighter, “Well that’s a bloody waste of time. I need you to give me some antibiotics for this now and make the wait worth my time. I haven’t got time to come back if it gets worse, I need this sorting out now.”
Next, we turn our attention to his cough. Darren doesn’t cough up any phlegm and has no temperature. His chest is clear on examination. Again there is no reason to prescribe antibiotics and this would be bad practice.
“You’re bloody no good. You call yourself a doctor?” Darren sits up even straighter and leans forward a little.
Darren’s last problem is the itchy rash on his leg. So far, he has not tried anything for it, instead wants me to sort the problem for him. On examination there is mild eczema and I advise him to use a moisturiser for it. When I offer to write a prescription, Darren refuses and leans forward more, invading my personal space as he does, “You’re a bloody disgrace, you’ve kept me waiting for half an hour and done nothing for me.” Darren stands up and struts out of the room, slamming the door behind him.
I let out a deep breath of relief and wonder how I could have handled that better. Hopefully, his rants are sufficient for him, but I fear more is to follow. Is this job even worth it?
A few hours later, after a message from the Practice Manager:
Before I leave for my visits, I take more prescriptions and paperwork to reception and then walk upstairs, use the bathroom and go to see the practice manager as she requested earlier. My stomach is grumbling, but it will need to wait for now.
Although I’m not sure what she needs to talk to me about, I suspect something is wrong as she often only asks to speak to us if a complaint has been received. After knocking on her door and entering, Claire greets me, “Busy day today?”
When I confirm it has been rather busy, Claire gets to the point, “Sorry, I’m not going to make your day any better. I received a complaint about you this morning. A patient you consulted this morning complains you were rude to him after already having left him waiting for over half an hour and then neglecting to give him the appropriate treatment for his problems.”
Three guesses who that complaint is from. Why on earth do I still try? Whatever we do, it is never good enough. Sometimes it seems better to just say to a patient, you are right, I’m a bad doctor and I will put in my resignation right now. That is not actually true though. The majority of patients are very grateful for what we do, it is just patients like Darren, who make you doubt your conviction to your job. After reading his letter of complaint, I go over the consultation in my mind. Had I been rude? I’m sure I remained civil throughout the consultation, even when he called me all sort of names. If anyone was rude, I consider it to be Darren, but maybe I’m in the wrong here after all. How one person sees a situation is not always how another person sees it. right?
Should I have given in to Darren’s pressure to prescribe antibiotics? Although it might have partially avoided the complaint, it would have been bad practice. Giving antibiotics when the situation does not require them, leads to bacteria developing a resistance to the antibiotics. These bacteria no longer respond to antibiotics and suddenly become killers. No, I’m not willing to enable this behaviour, complaint or no complaint.
Perhaps I should have been more compliant and not informed Darren we only allow one problem per consultation. However, patient education is important and if a patient is not aware of the fact he is supposed to book a longer appointment if he brings more than one problem to a consultation, he will continue to bring several complaints to one appointment in the future, ‘to save time’. In fact, it leads exactly to what he also complained about, having had to wait for too long a period. Half an hour he had mentioned. I was certain it was less than half an hour. Unless, of course, Darren included the wait from the time he arrived at the surgery to his appointment time and the quarter of an hour he had to wait after his appointment time.
At the moment my mood has plummeted, I’m hungry and there is still a lot of work ahead of me today. Now, I will first need to get ready for the visits and deal with the work during the rest of the afternoon. And when I have a moment, I will need to respond to that complaint. Dutifully apologise for any upset I have caused him and for the rude behaviour I was not aware I displayed. Really, why do I still try?
It's looking great
ReplyDeleteThanks, Grant, much appreciated.
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