Complaints from grieving relatives

COMPLAINTS are an everyday fact of life and at MDDUS we assist thousands of members from all areas of practice with advice about the most appropriate way to move forward. This can include initial guidance about investigating the complaint, the wording of a reply, or detailed involvement with serious complaints which progress through several stages.

Complaints from grieving relatives can be among the most difficult to respond to. These may involve individuals who you have not encountered before, challenging the care and treatment of their loved one and making allegations about your standards of practice. Not having an existing relationship with the complainant can compound difficulties in an already emotionally charged situation.

There is also the emotional response of those complained about to consider. Where a doctor has had a good relationship with a patient, who never raised any concerns about their own care, it can be difficult to accept a version of events presented by a relative.

Poor handling of such complaints is likely to lead to protracted correspondence, failure to resolve the issues, escalation of the complaint and missed opportunities to improve practice. Responses require sensitivity and tact, thorough investigation and clarity in replying. Many practitioners can feel very defensive when dealing with such cases and their own emotional response can interfere with their engagement in the process. In some cases, respecting the confidentiality of the patient can also be a barrier and this aspect needs careful handling.

When formulating a response there are some basic steps to consider.

The opening must be polite and conciliatory. Put yourself in the position of someone who is grieving and has concerns about a loved one’s care. What reply would you expect to receive? The first paragraph will probably have the greatest influence on the reader. The complainant may have had no prior knowledge of the practice or the doctors being complained about – their main impression may be determined simply by the tone of the reply letter.

In regard to content, it is essential to identify all the issues the complainant wishes to have addressed. If in doubt, list the issues you have identified from the complaint and then detail the steps taken to investigate these issues: for example, a review of medicals records, discussions with staff, the obtaining of reports, etc. These should be clearly described.

Increasingly, significant event review (SER) forms part of an initial investigation, particularly where a patient has died. There are many templates available online which are clear and straightforward to follow and provide for a comprehensive and useful SER. More detailed information on SER is also discussed in episode 3 of the MDDUS Risk Bites podcast.

All of the issues identified in the complaint must be addressed. If a numbering system has been used in the initial identification of concerns, it is helpful to use the same numbering system for the response. This aids clarity and avoids errors in omitting to comment on pertinent matters.

Be aware of the emotions of the complainant throughout your response, including the potential impact of terms and expressions used. It is best to write in full and proper English; avoid using “medical speak”.

Some of the draft responses we see at MDDUS can be too defensive: for example, they focus on statistics which show how good the practice is, or counter negative comments about members of staff by stating that no one else has ever complained. Complainants who are already upset at having lost a relative/friend may become even more distraught if a response does not deal with the issues raised. Any reply which appears to avoid answering difficult questions will only inflame matters further.

Take care to ensure accuracy and this includes simple matters such as checking that the patient’s name is always spelt correctly. Such “small” errors can be very distressing to relatives and can make resolution of the complaint even more difficult.  

Responses should always include an offer to meet with relevant practice staff – or to discuss alternatives to a meeting if this is not practical because a complainant lives in another part of the country. All responses should also inform the complainant of their right to raise concerns with the ombudsman (along with contact details) if they are dissatisfied with the practice response.

Time and effort spent on an initial reply is more likely to resolve a complaint. A hasty or incomplete investigation – revealing a lack of proper attention to detail – may compromise early resolution and increase the likelihood of extensive corrective recommendations from the ombudsman and risk escalation of the complaint to the GMC. It is noteworthy that a significant number of GMC cases arise where there have been communication difficulties between doctors and grieving relatives.

Members should also seek MDDUS advice where a complaint requires significant investigation.

ACTION: Be sensitive to the reactions of grieving complainants in relation to every aspect of your response. If conducting a SER follow professional guidance to produce a comprehensive review which will properly inform the complaint reply and assist with personal and practice development.