By Dr. Shan Lu and Dr. Kaili Hoffart
Patient A was admitted due to weakness, falls, failure to thrive. He was still driving prior to admission. However, his cognitive screen revealed red flags about his ability to drive safely. After discussion with the patient, the attending physician filed a form to Alberta Driver Fitness Monitoring. Patient A complained to the CPSA, outlining that the cognitive screen was not warranted and felt that the conclusions made regarding driving safety were erroneous. The complaint was initially rejected by the CPSA complaint director. The patient then appealed to the Complaint Review Committee (CRC). The CRC decided to review the complaint and had asked the physician to submit a written explanation. The physician contacted the CMPA and was assigned a case physician who helped to review and explain the CRC process. The attending physician then wrote a letter of explanation in reply to the patient’s complaints. The letter, all communications with the CPSA pertaining to this case, and all letters from patient A to the CPSA were reviewed by the CMPA physician. All this was then forwarded to a CMPA lawyer for review. The attending physician met with the lawyer to provide more information. The CMPA lawyer then modified the letter from a legal perspective. When the final draft had been approved by the physician, it was hand delivered to the CPSA prior to deadline set by the CRC. Throughout the process, the CMPA was responsive and reassuring.
It is almost inevitable that at some point a disgruntled patient will express their views to the college. Approximately 60% of all practicing physicians will have a patient complaint registered against them at some point in their careers.
A recent article entitled “Complaints Should be Something to Smile About” in The Medical Post written by Donalee Moulton highlights just this:
Patient complaints strike fear into most physicians. The deputy registrar of the College of Physicians and Surgeons of Saskatchewan (CPSS) would rather they bring a smile to doctors’ faces. “My goal is that when a physician receives a complaint to jump up and say, ‘Yes! This is a chance to improve my practice,’” Dr. Micheal Howard-Tripp told the Medical Post in an interview.
There is no room for complacency when it comes to complaints, he added. Approximately 60% of all practicing physicians will have a patient complaint registered about them at some point in their career.
Dr. Howard-Tripp recommends doctors first read the letter discussing the complaint. Then, he said, they should put it down. “Let your emotions settle.”
Although it may sound counterintuitive, it is also helpful to talk with colleagues. “When a physician gets a complaint, they tend to hold it very close to their chest. My recommendation would be to share it with others. Complaints often reflect systemic problems,” noted Dr. Howard-Tripp.
He also suggests doctors take the initiative and offer up a solution to the problem highlighted in the complaint. For example, if a doctor reviews their patient notes and concludes they were inadequate or incomplete, it can be helpful to acknowledge this and undertake a continuing medical education program directed at this practice area.
The solution may be acceptable to the patient and help resolve the complaint, especially if the issue is not seen as serious. Even if the solution is not accepted, the physician’s effort to resolve the issue will be well received by the regulator. That would stand in their favor, said Dr. Howard-Tripp.
In an article Dr. Howard-Tripp wrote on the issue in the most recent issue of the CPSS magazine, DocTalk, he stressed that honesty – with yourself – is also the best policy. “Honestly reflect upon the communication style you used. At times we physicians don’t realize that our communication style is not effective for certain patients. If there are improvements you could make in your communication, acknowledge these and the opportunity to improve.”
Physicians must also recognize that each complaint stands on its own and defaulting to the status quo in response to a complaint is not acceptable. Dr. Howard-Tripp points out that many doctors, for example, respond to complaints by stating “it is my usual practice.” “That doesn’t help us,” he noted. “We want to know what happened in this situation. Your response needs to satisfy the patient.”
Receiving a complaint can mirror the process of grief. Physicians will frequently go through stages of shock, anger, rejection and acceptance. It may be helpful to have professional advice along the way. Dr. Howard-Tripp encourages physicians to speak with the Canadian Medical Protective Association. “It’s better to correct any mistakes at the beginning.”
Do not hesitate to reach out to the CMPA early on in this process to request assistance and guidance. Their guidance and support not only helps to ease anxiety but ensures all necessary steps are followed. For further information or questions regarding CMPA assistance and legal issues, the Association can be reached at 1(800) 267-6522. If you call, you will be placed in direct contact with a physician advisor who can provide confidential medical-legal advice.