Patient complaints in general practice seen through the lens of professionalism: a retrospective observational study.

Pieter C Barnhoorn,Anneke Wm Kramer,Walther Nka Van Mook,Mattijs E Numans,Geurt Tjm Essers,Vera Nierkens

doi:10.3399/bjgpo.2020.0168

Abstract

BackgroundProfessionalism is a key competence for physicians. Patient complaints provide a unique insight into patient expectations regarding professionalism. Research exploring the exact nature of patient complaints in general practice, especially focused on professionalism, is limited.AimTo characterise patient complaints in primary care and to explore in more detail which issues with professionalism exist.Design & settingA retrospective observational study in which all unsolicited patient complaints to a representative out-of-hours general practice (OOH GP) service provider in The Netherlands were analysed over a 10-year period (2009–2019).MethodComplaints were coded for general characteristics and thematically categorised using the CanMEDS Physician Competency Framework (CanMEDS) as sensitising concepts. Complaints categorised as professionalism were subdivided using open coding.ResultsOut of 746 996 patient consultations (telephone, face-to-face, and home visits) 484 (0.065%) resulted in eligible complaint letters. The majority consisted of two or more complaints, resulting in 833 different complaints. Most complaints concerned GPs (80%); a minority (19%) assistants. Thirty-five per cent concerned perceived professionalism lapses of physicians. A rich diversity in the wording of professionalism lapses was found, where ' not being taken seriously ' was mentioned most often. Forty-five per cent related to medical expertise, such as missed diagnoses or unsuccessful clinical treatment. Nineteen per cent related to management problems, especially waiting times and access to care. Communication issues were only explicitly mentioned in 1% of the complaints.ConclusionMost unsolicited patient complaints were related to clinical problems. A third, however, concerned professionalism issues. Not being taken seriously was the most frequent mentioned theme within the professionalism category.

Highlights

Professionalism is a key competence for all physicians.[1]
Research exploring the exact nature of patient complaints in general practice, especially focusing on professionalism, is limited
To investigate the exact nature of patient complaints in of-hours general practice (OOH GP) care, with a special focus on perceived professionalism lapses of physicians, a detailed content analysis was performed of original unsolicited patient complaints lodged at an OOH GP centre

Summary

Introduction

Professionalism is a key competence for all physicians.[1] Lapses in physicians’ professionalism may affect health outcomes, therapeutic relationships, and the public’s perception and trust in the medical profession.[1,2,3,4,5,6,7,8] Perceived professionalism lapses are part of patient complaints in all healthcare settings.[6,9,10,11,12,13] GPs are especially vulnerable to patient complaints.[13,14,15,16]. Patient complaints provide unique and important insights into people’s expectations, especially as unsolicited complaints contain spontaneously provided information reflecting issues that are of high importance to patients and are not being captured otherwise.[5,6,10,17] Complaints reflect patients’ expectations about provided care, especially concerning professionalism. Not being taken seriously was the most frequent mentioned theme within the professionalism category

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