Honest regrets

A PATIENT – Mr C – attends his local surgery complaining of weight loss and pain on urination. A GP examines him and orders blood tests but there is no obvious explanation and over the next 11 months the symptoms persist with the patient attending the surgery numerous times. Mr C is then referred to hospital for GI investigations but no cancer is found in the bowel or stomach. Another six months pass before the GP detects a large swelling in Mr C’s abdomen. He is offered a nonurgent referral for a CT scan which leads to a diagnosis of kidney cancer.

Mr C writes to the practice complaining about his clinical care and the attitude of the GP. The practice investigates but the GP insists that no mistakes were made. The complaint response is later characterised as “lengthy, cumbersome and defensive”. An apology of sorts is offered but caveated with the phrase: “although ultimately we are all humans with human frailties”. Mr C receives the response two days before he dies.

The patient’s wife then complains to the practice and the reply is again highly factual with no mention of regret for her loss or acknowledgment of any mistakes – nor even condolences.

This case was highlighted in a 2016 report by the Parliamentary and Health Service Ombudsman (PHSO) on how some GP practices handle complaints. An analysis of 137 closed complaint cases by PHSO investigators rated complaint handling in 36 per cent as “Needs improvement” and in 10 per cent as “Inadequate”. In a third of cases practice staff did not provide an adequate apology where appropriate, and apologies when offered were not always sincere.

Receiving a complaint from a patient is the most common reason doctors seek advice from MDDUS and this accounts for around a fifth of all the contacts we receive. Many of these complaints could be resolved with an apology and an honest and direct explanation.

Some doctors, however, are reluctant to apologise, believing that saying sorry is an admission of guilt or liability in any potential negligence claim. This is not the case. The Compensation Act 2006 states: “An apology, an offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty”.

Nor is offering an apology a sign of weakness. In fact, at times, not only is it the right thing to do, it is also a doctor’s duty. There is both professional and statutory guidance on when and how it is appropriate to apologise. The GMC’s Good Medical Practice provides general guidance to doctors in regards to the professional conduct expected of them. This includes saying sorry when appropriate and providing a full and timely explanation in a manner suited to individual concerns. NHS complaints procedures in the various UK countries impose a similar obligation on doctors.

No doubt it can be stressful receiving a complaint but you should avoid acting defensively. An open and honest approach can help resolve complaints at the earliest possible stage and prevent them from escalating into negligence claims or a matter for professional regulators.

Professionalism requires doctors to be honest and responsible and act with integrity. You should show empathy and respond objectively after consideration of the patient’s point of view. A sincere expression of sorrow or regret should be offered at the earliest opportunity, as well as an explanation of what went wrong.

You should use appropriate language and tone, and avoid medical jargon. In our experience, most patients who complain are not interested in pursuing long and drawn-out formal complaints. Often just listening and understanding their concerns can defuse a situation.

Even if you don’t believe a mistake has been made, it is still helpful to adopt a conciliatory tone and express regret that the patient is dissatisfied. Patients want to know that their doctor cares and understands their concerns. They want their doctor to be honest and responsible.

It is also important to try to learn from complaints, reflecting on what has happened and identifying any changes in individual practice or systems that may be required. Changes of this kind may also be shared with the complainant to demonstrate that the matter has been taken seriously. Patient safety can be improved if you have a system in place to review and learn from mistakes.

The GMC’s Openness and honesty when things go wrong: the professional duty of candour provides further guidance to doctors about saying sorry. It also reminds doctors not to be formulaic in their responses, as an apology has value only if it is genuine.

In the case of Mr C, highlighted above, the complaint from his wife was escalated to the PHSO which found that numerous opportunities had been missed to refer the patient for appropriate investigations that might have led to an earlier diagnosis. It also criticised the practice and GP involved for the handling of the complaint. In the end the practice acknowledged and apologised for its failings and paid Mrs C £1,500 for the impact. It also produced an action plan to show what it had learned from the complaint.

Dr Greg Dollman is a medical adviser at MDDUS