Complaints and COVID-19

Dr Emma Davies, Medicolegal Consultant at Medical Protection, looks at how the COVID-19 pandemic has driven an increase in patient complaints

Complaints are not only time consuming to handle but they also have an impact on our morale. In these challenging times, when healthcare professionals are already under considerable strain, it can feel like the last straw when a complaint is around the care of a patient during the COVID-19 pandemic. 

There is a sense that the initial outpouring of gratitude and respect from the public has dwindled; most of us are fatigued and frustrated by COVID-19 and so are the general public. It is possible that this is being borne out in some of the complaint cases we are seeing at Medical Protection. 

Practice staff are now triaging all patients by telephone and consulting with many by telephone or video. But with the ‘new’ way of working through remote consulting comes an increased risk of misunderstanding, unmet expectations and dissatisfaction of the care that is offered or provided, which may result in a complaint.

When working with any limitation of resources, under increased pressure and being hindered by a lack of face-to-face contact with the patient, how can we communicate in ways that assure our patients that we still want to provide high quality patient care – while also conveying to patients and their relatives what is and isn't realistic?
In this article I will look at some of the common themes that are emerging in our complaint cases and provide examples of some scenarios we have encountered. 

The statistics

On average over the last ten years, our file handlers assist 3,000 members per year with complaint cases in the UK. In 2020 we assisted 2,224 members with complaints, so there was a significant decrease. In particular there was a decrease in the number of complaints in the months of March through to October 2020. By November we were seeing the usual kind of numbers of complaint cases coming in. 

What is driving the complaints?

Some complainants have described a sense of doctors using COVID-19 as an “excuse” for saving money by reducing or closing services – these comments have been made in particular where home visits or face-to-face appointments have not been offered. There have been frustrations that after the first lockdown people were able to go to pubs, restaurants and shops, and yet were still unable to see a GP face-to-face. These perceptions by the public demonstrate a misunderstanding on their part, and it must feel extremely unfair when doctors become the target for the public’s frustration around regulations and guidance that have not been of their making. 

Common themes and the possible solutions

Difficulty getting access to services: Looking at things from a patient’s perspective, having to listen to a long pre-recorded message around the changes to practice because of COVID-19 may set a negative tone and increase the risk of patients becoming frustrated. It may therefore be worth revising the practice’s outgoing recorded message to set the tone of the patient journey. Keeping it short and explaining what the practice can do, rather than what they can’t do, may help. 

It may also help to look at alternative routes of access to care; an example being the use of e-consultation platforms.

Not offering face-to-face appointments or signposting to hospital: At the beginning of the pandemic some patients were led to believe that there was no opportunity for face-to-face consultations. This is despite the guidance that face-to-face consultations could be provided if clinically indicated, or at the very least patients could be signposted to alternative clinical provisions such as the Emergency Department, if appropriate. 

Remote consultations have been a steep learning curve for some where other practices may have been doing triage calls prior to the pandemic. Remote consulting is a skill and as doctors we need to make sure we are asking the right questions and not making assumptions. Safety netting and signposting is more crucial than ever to help avoid patients feeling abandoned. 

The GMC issued helpful guidance on the use of remote consultations, which can aid decision making when assessing if a face-to-face appointment should be considered. Medical Protection has also published an article on remote consultations. 

Assuming it is COVID-19 when it isn’t (COVID-19 blindness): Keeping an open mind is even more important during remote consultations: “Not all that coughs is COVID-19.” We need to make sure we are not pigeonholing patients into a diagnosis without considering the alternatives; again, this is about asking the right questions during the consultations.

Delay in cancer diagnosis: This has always been a common complaint theme. But with the restriction of remote consultations and the perception that cancer services were not running at all (as opposed to a reduced or changed service) led to many complaints.

Grief and displaced anger: From my experience as an emergency medic and talking to relatives of the deceased, it has been apparent to me that the impact of social distancing and not being able to be with or see loved ones when they are ill has led to an increased likelihood of complaints towards healthcare providers. Much of the anger is borne out of a sense of needing to “fill in the gaps” about what happened and a sense of loss and guilt that they could not be there. Empathising with bereaved relatives and understanding how difficult this must be for them has helped reduce complaints. 

Putting complaints into context

In September 2020, the GMC issued guidance to its own staff, urging them to weigh any complaints about doctors against the pressures of the COVID-19 pandemic. Medical Protection had been calling for this greater level of understanding for some time and welcomed the GMC’s move.

Dr Rob Hendry, Medical Director at Medical Protection, said: “We have continually urged the GMC to acknowledge the extraordinary circumstances of the pandemic and issue a statement of reassurance that it will show restraint and only open an investigation where there is a serious concern about a doctor’s fitness to practise. 

“This GMC staff guidance setting out how to take the COVID-19 context into account when considering complaints, will be welcomed by doctors, many of whom have had the stress of the pandemic compounded by the prospect of a regulatory investigation.”