Most GPs offer an excellent service to patients most of the time. But given the thousands we see every year, it's inevitable we sometimes get things wrong and you may feel the need to complain.
So what causes complaints and what sort of response should you expect from your GP?
According to a recent report from the Healthcare Commission, people complain most about overly brisk GP consultations and failure or delay in diagnosing a condition. The report looked at more than 10,000 complaints the commission independently reviewed between August 2006 and July 2007, of which 3,700 were within primary care.
It doesn't surprise me so many complaints concern brief consultations and examinations, and limited discussion about treatment options (about 43 per cent according to the report).
There's no excuse for taking dangerous shortcuts, but the average consultation seems woefully inadequate for the increasingly complex problems GPs are expected to deal with. It's OK for a contraceptive pill check or a sore throat, but a thorough examination and discussion takes much longer.
Increasing consultation times to 15 minutes or more sounds like the obvious solution, but the longer we spend with each patient the fewer can be seen each day. And that means you have to wait longer for an appointment, which is another source of complaints. The solution is having a more realistic ratio of GPs to patients.
Missed diagnosis
As for missing or delaying a diagnosis such as cancer, this can be bad news for patients - and a nightmare for your GP. The report found in about one in five complaints patients felt their doctor had missed signs or hadn't referred them to a specialist early enough.
There are clear national guidelines on when to refer people with suspected cancer for specialist assessment - and in most cases the commission found GPs had acted appropriately - but it also recommends GP practices review their own procedures.
Poor attitude
About one in five complaints was about GPs' poor attitude, including rudeness, not listening to patients (perhaps because they were too busy looking at the computer?) and an unwelcoming surgery environment.
A number of complaints were about the poor attitude and behaviour of practice managers and receptionists.
GPs were often accused of not bothering to discuss treatments' side-effects, as they assumed patients wouldn't understand the complex information.
Making a complaint
This procedure can be stressful, both for you and your GP. I know the threat of complaints looms large in the minds of most GPs, and can be a major cause of stress.
But if a complaint is handled well, it can lead to a satisfactory resolution for you and a chance to improve things for the practice.
More than half of those who complained simply wanted either an apology or a better explanation
The commission's report shows more than half of those who complained simply wanted either an apology or a better explanation or recognition of what had happened.
Unfortunately, the report describes many cases where GPs failed to engage with the complaint, sometimes reacting defensively. But where GPs responded positively and professionally at the outset, complaints were usually resolved more quickly at a local level without the need for the Healthcare Commission's involvement.
One of the report's key recommendations is that GPs ought to make patients aware of the practice's complaints policy (every practice should have one) and offer to arrange meetings between patients and staff to try to resolve problems in a less adversarial way.
If at all possible, it's often best to see the GP involved, or the practice manager, to explain your concerns before making a formal complaint. You may be able to sort things out to your satisfaction simply by getting answers to your questions or a frank apology for what happened.
Making a complaint
In my experience, GPs are sometimes often reluctant to meet patients this way, and avoid saying 'sorry' for fear of admitting liability. But the Medical Defence Union, which assists many GPs with complaints, is clear about how to respond.
Dr Hugh Stewart, MDU medico-legal adviser, says: "It's extremely important doctors realise that saying 'I'm sorry this has happened to you' is not the same as admitting liability. In many cases, a prompt and genuine apology is all a patient wishes to hear, and may prevent a complaint from escalating."
The MDU also recommends practices and local health trusts should have a dedicated complaints manager, that GPs should respond to complaints promptly, and that the tone of any response to a patient is professional, measured, sympathetic and tries to address all of the patient’s concerns.
No one wants to have to make a complaint - and I can't imagine any GPs relish receiving them - but GPs do have the potential to prevent similar mistakes happening again and, ultimately, improve the service for patients.
Dr Graham Easton works in a London GP practice with around 10,000 patients. It has three GP partners, three salaried doctors and fully computerised medical records. His medical training was at The Royal London Hospital. He's also an experienced medical journalist who has worked for BBC Radio Science and the British Medical Journal.
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