A Vice Chair of the ICRC provides advice
As a physician, I know how upsetting it is to learn that a patient has complained about you. I also know that all of us strive to deliver the best care possible to our patients and it can be jarring to find out that a patient is unhappy.
While dealing with a complaint can be an uncomfortable experience, it can also be a valuable one, because it offers an opportunity to look at an aspect of your practice through the perspective of a patient. After all, we all have our blind spots, and we all have areas where we can improve.
For the past five years, I have been a member of the CPSO’s Inquiries, Complaints and Reports Committee (ICRC), the committee that oversees all investigations into physicians’ care and conduct. For the past two years, I have been a Vice Chair of the Committee.
Recently, I was asked by my medical school to give a presentation on best practices for reducing the risk of a complaint. As I put together the presentation, it struck me – and not for the first time – that so many of the complaints that we see around the ICRC table have recurring themes, with a disproportionate percentage of them rooted in communication issues.
In the spirit of sharing some insights straight from the ICRC table, here are a few tips on how to minimize your chances of a formal complaint:
- Discuss the rationale for your clinical decisions with patients and listen to their concerns. Talk about why a treatment is necessary – or not necessary. Such conversations don’t need to take a long time, and they can often mean the difference between a patient leaving their appointment with the sense that their feelings have been validated and respected or leaving the appointment with feelings of discontent.
- Use language and a tone that is respectful and empathetic. Yes, it’s true – our clinical days are busy and we are working in an over-stressed system, however, we need to be mindful that we are seeing people at their most scared and vulnerable, and they need kindness.
- Ensure that you have a system in place that allows you to manage test results effectively so that you can follow up on concerning results.
- Be respectful of patients during intimate examinations. Explain what areas of the body you will need to examine and why. Get their consent before you begin, and always use sensitive draping techniques. [If you need advice in this area, read the article on draping published in the Issue 4, 2018 of Dialogue].
- Be mindful of the prescribing guidelines for opioids and other controlled substances. The CPSO knows very well that some patients will have different needs that will dictate prescribing outside the recommended guideline, but starting with an evidence-based approach puts you on solid footing to apply your own clinical judgment.
- Respond in a timely way when patients or their representatives – ask for copies of their medical record. I can almost guarantee that a patient who is forced to ask repeatedly for their record will make a complaint.
- And lastly, I can’t stress enough the importance of solid documentation. Good medical records are important for many reasons, not the least of which is to ensure a patient’s continuity of care. And in the event that a complaint is lodged against you, good medical records will provide a window on the clinical judgment that you exercised during the clinical encounter. A complete, up-to-date, legible and accurate medical record can make all the difference to the outcome of the College’s investigation.
Dr. Akbar Panju is a vice chair of the Inquiries, Complaints and Reports Committee, and Professor of Medicine at McMaster University.
