guide is intended for a psychiatrist against whom a complaint has
been made. The information can be used as a guide only and is not a
substitute for professional advice. If you need further advice and
support, please contact the Psychiatrists’ Support Service or one
of the organisations listed at the end of the information
Complaints about psychiatrists are inherently
likely because part of psychiatrists’ professional responsibilities
may be to articulate opinions with which the patient and/or their
family may disagree.
This leaflet aims to outline the various
mechanisms of complaint, how to respond, and in particular what to
do in the case of repeated complaints from the same source.
Very often, if a patient
or their family complains, sitting down together to clarify the
issue and apologise if appropriate is sufficient. This must be
recorded in the notes and ideally witnessed by another team member
or a secretary.
Formal complaints to the NHS trust
- Trusts have formal
complaints mechanisms in place, and you will be asked for your
response in order to facilitate local resolution.
- You will need to review
the case notes and respond fully to every point outlined in the
complaint, acknowledging with regret any shortcomings, and giving
- Ensure that you read the
response letter before it goes out.
- A meeting with the
complainant and the complaints manager may resolve the issue.
- Appeals are not unusual,
and may be sent for local independent review and then to the Health
Service Ombudsman, depending on the jurisdiction. Appeal processes
may not confine themselves to the complaint and may also evaluate
- Disciplinary procedures
may arise from complaints.
- It is advisable to
contact your defence organisation at an early stage.
Complaints to the General Medical
Many complainants are
advised by the GMC to use the National Health Service (NHS)
complaints procedure and complain to the trust concerned. If the
GMC decides to investigate further (about 50% of cases), it will
first write to the doctor to confirm their employer and then
contact the latter to disclose the complaint and enquire whether
there are any concerns.
- Try not to feel
intimidated by the complaint and do not ignore it.
- Contact your defence
organisation for advice and assistance in writing letters of
- The Psychiatrists’
Support Service may be helpful in providing support and
- You may have to discuss
the complaint further with a GMC case examiner.
- Respond factually and
- Provide a response to
each separate point/allegation within the complaint, outlining the
reasons for your actions where possible.
- Take emotion out of the
response to the complaint. For example, if a complainant states
that you were rude, but you do not think you were, then state
something along the lines of ‘I regret if Mr X feels that I came
across in a rude manner…’
- The GMC asks for
responses usually to be provided within a 28-day period. Let them
know if it is going to be difficult for you to meet this
- If you are aware that
the letter has come from a ‘serial complainant’ then tell the GMC.
State instances where previous complaints have been made and the
stage that these reached.
Persistent and organised complaints
Some trusts recognise
within their complaints policy the phenomenon of the persistent or
vexatious complainant. For instance the complaints are repeated,
differing only in minor detail, and unsubstantiated. A decision not
to investigate such complaints further may be made at a senior
level by the chief executive.
While psychiatrists are
vulnerable to the possibility of repeated complaints from a single
patient or family member, some specialties are the target of
organised pressure groups, especially those working with children,
or in liaison or forensic psychiatry.
The GMC is alert to this possibility and looks
out for instances of repeated language, letters from particular
organisations or individuals, the style of writing, complaints
about the same aspects of care, or the same groups of doctors and
so on. Nevertheless, there is no policy for dealing with organised
groups, and as the GMC is more likely to investigate if there are
several complainants, clearly orchestration is a possibility.
Frequently asked qestions
Q: How can I
reduce the likelihood of complaints?
- Remain courteous and
calm and try to ensure the patient and family feel understood and
cared about as this may defuse a difficult situation. Show
flexibility in negotiating solutions.
- Be aware that patients
and relatives may have access to your written notes or letters, so
imagine them reading them as you write them.
- Make sure your notes are
dated and legible and the grounds for your decisions are
- If the decision is
likely to be contentious (for instance referral to child
protection), it is often advisable to consult a colleague and make
a note of this.
Q: What are the characteristics of a persistent
- Lester et al (2004)
found that persistent complainants were distinguished by their
pursuit of vindication and retribution, consumed much time and
resources and resorted to both direct and veiled threats. Nearly
three-quarters were men. Their communications showed more
idiosyncrasies of language, for instance misusing legal and medical
terminology and often using rhetorical questions. They could be
both intimidating and ingratiating, and often attached many copied
documents thus building up large case files.
Q: How do I know and what do I do if a patient already
belongs to a pressure group?
- First, be aware of the
views of the interest groups in your area of practice, as there are
often opposing ones.
- The patient is quite
likely to tell you of their links and/or may bring downloaded
information. Knowing whether or not their beliefs are fixed will be
helpful in guiding your treatment considerations.
- Many support groups,
while perhaps espousing one solution over another, are very
valuable for patients. A minority, however, do campaign by
attacking professionals both as groups and individuals. Looking at
their websites will give a guide to their approach, methods and
Q: How do I cope when unreasonable complaints seem to be
given so much attention?
- Unfortunately, this
‘goes with the territory’, as in psychiatry complaints may arise
from illness, shortfalls in resources and/or the necessity to use
compulsion, or report to other authorities. It is therefore
important for the patient/complainant’s view to be heard.
- It does happen that with
the urge to blame, the psychiatrist is an easy target, even
scapegoat, with an issue sometimes being a proxy for other
management or intra- or inter-professional difficulties.
- You may be sure you are
in the right, or filled with self-doubt. In any case, the situation
may well be stressful and possibly the uncertainty about the
outcome may be prolonged, so make sure of all support possible,
from friends, family, colleagues and professional
Sources of further help and support
BMA House, Tavistock Square
London WC1H 9JP
Tel: 020 7387 4499, Fax: 020 7387 4499
Hospital Consultants and Specialists
1 Kingsclere Road, Overton,
Hants RG25 3JA
Tel: 01256 771777, Fax: 01256 770999
MDU Services Limited, 230 Blackfriars
London SE1 89J
Tel: 020 7202 1500
Medical Defence and Dental Union of
Mackintosh House, 120 Blythswood
Glasgow G2 4EA
Tel: 0141 221 5858
33 Cavendish Square, London W1G 0PS
Tel: 020 7399 1300, Fax: 020 7399 1301
Royal College of Psychiatrists
17 Belgrave Square, London SW1X 8PG
Tel: 020 7245 0412
LESTER, G., WILSON, B.,
GRIFFIN, L., et al (2004) Unusually
persistent complainants. British Journal of
Psychiatry, 184, 352–356.
Acknowledgements to the General
Medical Council and the Medical Protection Society.
© Royal College of Psychiatrists 2008
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