Dr George Wright offers ways to tackle blue-on-blue complaints, and how to avoid going for the nuclear option if you have an issue with a colleague.
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FrogFest Virtual – The Boundary Hunters
Tuesday 25th November
if you've had a long career in healthcare, chances are that
Speaker:you've received a complaint.
Speaker:It could be about the way you spoke to a patient, a mistake,
Speaker:or simply misunderstanding about the treatment that you provided.
Speaker:And it's never been easier for people to complain, whether it's
Speaker:through a simple online form or just taking to social media.
Speaker:But a professional complaint from a colleague can land very
Speaker:differently and hurt us more deeply.
Speaker:This week I'm joined by Dr. George Wright, legal consultant and Deputy
Speaker:Dental Director of Dental Protection.
Speaker:Now, George had a complaint made against him earlier in his career, which he
Speaker:believes led him to the work he does now, helping other healthcare professionals
Speaker:navigate the complaints process.
Speaker:One of the things we discuss is the often unintended escalation that
Speaker:so-called blue on blue complaints may trigger even if the person wants
Speaker:to withdraw the complaint later.
Speaker:This often leads to long and drawn out proceedings on both sides, and
Speaker:often no resolution for either party.
Speaker:So we talk about what to do instead of going straight for the nuclear option and
Speaker:also when the nuclear option is necessary.
Speaker:And if you've experienced anything like this or you'd like to know what
Speaker:to do, should a complaint land on your desk, this in-depth conversation with
Speaker:George will give you the resources you need to take the right next step.
Speaker:If you're in a high stress, high stakes, still blank medicine, and you're feeling
Speaker:stressed or overwhelmed, burning out or getting out are not your only options.
Speaker:I'm Dr. Rachel Morris, and welcome to You Are Not a Frog.
Speaker:My name's George Wright.
Speaker:I'm a general dentist by background.
Speaker:I now work full-time for Dental protection, Which is part of the Medical
Speaker:Protection Society as a dental legal consultant and deputy Dental Director.
Speaker:is great to have you on the podcast, George.
Speaker:Thank you so much for coming on.
Speaker:and I think this conversation's going to be really interesting because the
Speaker:one thing that I know doctors, dentists, nurses, healthcare professionals,
Speaker:fear above all things is complaints.
Speaker:And this fear of complaints drive so much of our behavior, uh, whether it's,
Speaker:you know, avoiding saying no, because we don't want to upset anybody, or
Speaker:just over investigating because we don't wanna get things wrong, or just
Speaker:doing stuff that we probably wouldn't normally do but just because we are
Speaker:so worried that, that the patient is upset or maybe one of our colleagues
Speaker:is, is, is watching over our shoulder.
Speaker:And so we end up making these decisions out of fear rather than
Speaker:out of our deep intuition, knowing that that's the best thing to do.
Speaker:So obviously you are a complete expert in this area.
Speaker:Um, just very quickly, what sort of complaints are you
Speaker:seeing at the moment in general?
Speaker:Well, yes, there has been a, a change in trends.
Speaker:Uh, we've had COVID, which of course is, was, you know, a complete anomaly
Speaker:in itself, but in more recent times, the real driver, I think, and the, the thing
Speaker:that’s really changed up the way patients approach their healthcare is social media.
Speaker:So with social media comes a real change in patient expectations.
Speaker:Patients are more aware of what they are, let's say, entitled to.
Speaker:They're more aware of what can be achieved and what can be delivered.
Speaker:Um, and they're also, uh, more aware of what tools they have at their disposal
Speaker:when things go wrong, be that complaints to clinicians directly or, you know,
Speaker:using social media itself as a, a tool to, uh, criticize their clinician.
Speaker:It's a whole new ball game, isn't it?
Speaker:And misinformation that's out there is really scary as well.
Speaker:So I, I asked one of my children the other day, where'd you
Speaker:get your information from?
Speaker:Oh, TikTok, she said.
Speaker:I said, okay, so how do you know if that information is
Speaker:true or not on TikTok, or right?
Speaker:And she said, oh, look at the number of likes it has.
Speaker:Oh no.
Speaker:I said, okay, but what, what else?
Speaker:She said, well, I look at who's commented, and like, if it's somebody
Speaker:famous, everyone knows it's commented.
Speaker:That's like, right, that, that it's right then that's probably okay.
Speaker:And I was just like, oh my goodness.
Speaker:So we are no longer believing experts are we?
Speaker:We, we are believing popular people.
Speaker:People that are famous people have got big followings.
Speaker:Oh my goodness.
Speaker:Yeah.
Speaker:No, that, uh, I mean, that's really interesting perspective.
Speaker:I suppose the answer is get a celebrity patient into, uh, boost your exposure.
Speaker:But that, you know, I, I think you're right.
Speaker:I think, um, misinformation is a problem.
Speaker:Where we see that in dentistry in particular is things, uh, like,
Speaker:just to give you an example, before and after clinical photographs.
Speaker:So a clinician can put some photographs on their Instagram, for instance, and, you
Speaker:know, you have no way of knowing whether those are credible photos of, of treatment
Speaker:that dentist has performed and completed.
Speaker:Um, and indeed you have no way of knowing what sits behind the photograph.
Speaker:Was that patient actually hap happy with the treatment?
Speaker:Was the dentist a good communicator?
Speaker:Did they deliver on what the patient was expecting outta the treatment?
Speaker:None of that is delivered through a, you know.
Speaker:short Instagram posting, is it?
Speaker:No, and that leads me onto my, the thing I'd like to talk about is complaints, um,
Speaker:doctor on Doctor or dentist On dentist or, you know, in interprofessional, because,
Speaker:you know, we've talked a bit on this podcast before in Association of Medical
Speaker:Protection Society, and we'll, we'll put the links in the show notes about how
Speaker:to deal with failure, manage yourself through complaints and things like that.
Speaker:But what about when it's one of your colleagues complaining about you?
Speaker:And I can imagine that when you see in social media some misinformation being
Speaker:spread by some quite prominent characters who, identify as doctors or as dentists
Speaker:or my pet bug bear is nutritionists.
Speaker:There are some absolutely fantastic, very good nutritionists out there.
Speaker:Big shout out to, uh, the, the, the Doctor's Kitchen 'cause they
Speaker:are brilliant and a, a, a GP that runs that really good stuff.
Speaker:But there's some stuff out there that is just completely wrong and making people
Speaker:spend so much money on stuff that's not gonna help or might even be dangerous.
Speaker:And when you see that you think someone's got to do something about this, they need
Speaker:to be reported to the GMC for, for putting that on, on on Instagram, you know,
Speaker:but that's not always helpful, is it?
Speaker:But I think that is a reaction when we as healthcare professionals see
Speaker:another healthcare professional doing something we think is wrong.
Speaker:And the problem is that can be really, really destructive, can't it?
Speaker:I mean, there's that macro level of you don't know them at all, they're on
Speaker:social media, they're a prominent figure.
Speaker:But then there's that micro level of, of people you might even be working with.
Speaker:Yeah, and I think, I think to the point we've just been talking about in, in
Speaker:regards to social media, perhaps not actually representing things, the
Speaker:same is true with the, impression that one clinician might gain of another.
Speaker:It, it's a very, uh, narrow insight into what's going on, and there's
Speaker:always a story that sits behind what might be causing you concern.
Speaker:I think you're right.
Speaker:I think, you know, what we, we would say is blue on blue, you
Speaker:know, is, is the term used for these so-called clinicians complaining
Speaker:about other clinicians and they've, they've absolutely got their place.
Speaker:Don't get me wrong.
Speaker:You know, if, if you see something taking place that's putting patient
Speaker:care at risk, of course you have a, an ethical and a professional
Speaker:responsibility to raise those concerns.
Speaker:It doesn't always have to be the case that you have to reach for the nuclear
Speaker:option and refer them to the regulator.
Speaker:it's important I think, to look behind what your motivation is for making
Speaker:that report and whether indeed the, the mechanism that you have in mind is the
Speaker:most appropriate mechanism or whether there might be something more suited.
Speaker:because.
Speaker:Why is it that most of us, most, I say most of us, I've never done this, but
Speaker:a, a lot of blue on blue complaints are directly to the regulator.
Speaker:They're directly already at the escalation stage, rather than
Speaker:starting from the, the bottom of the escalation pyramid, which is something
Speaker:I'd like to ask you about in a bit.
Speaker:Yeah, I think, I think that's a really good question.
Speaker:I think there's probably two reasons.
Speaker:I think one is a misunderstanding of the mechanisms that are available, so using
Speaker:that escalation process, making sure that you are pitching your complaint or
Speaker:concern at the right level to get it dealt with effectively but proportionately.
Speaker:And I think the other reason, and this is perhaps more cynically, uh, pitched,
Speaker:is that if an individual has themselves been in the recipient of a complaint to
Speaker:the regulator, particularly by another professional, then emotionally, I think
Speaker:often the response is to retaliate with a similar complaint to the same regulator.
Speaker:And so I think it's really important to really, I suppose, look inwards before
Speaker:you make any reports, any complaints, really scrutinize your own motivations
Speaker:for doing that, and take advice so you can understand whether indeed that is
Speaker:the most appropriate course of action to get the outcome that you are looking for.
Speaker:so much in that, isn't there?
Speaker:So I think first of all, yes, it's a motivation.
Speaker:Like why is it that I'm making this, making this complaint?
Speaker:Is it to correct stuff that's factually wrong?
Speaker:In which case, yeah, why would you go to the GMC?
Speaker:Why wouldn't you just message them?
Speaker:And I know, you know, when we put stuff out on Instagram about burnout
Speaker:and stress and resilience, um, if we ever get any pushback from people or
Speaker:complaints or, or people right to us, occasionally we do get some feedback about
Speaker:stuff, I take it really seriously and I, I always change things and I always
Speaker:look at what we're doing and thinking is, is that, is that right or not?
Speaker:So I think people maybe assume that their feedback isn't going to be listened to.
Speaker:I think that firstly, most feedback is really listened to
Speaker:and it's really, really valuable.
Speaker:So there is that, that that motivation about is it, 'cause I
Speaker:want to correct stuff out there.
Speaker:I guess when it comes to the social media type stuff, there might be a bit
Speaker:of jealousy on people's, you know, if there's a very, very prominent doctor or
Speaker:psychologist in the, in the media, people just wanna have a pop at them, don't they?
Speaker:And, you know, I do think that happens a bit as well.
Speaker:I, I think that's absolutely right.
Speaker:So I, um, I'm, I'm joining you today actually, as it happens from Hong Kong.
Speaker:NPS has a me, uh, a, a presence all around the world, and, uh, one of our
Speaker:significant jurisdictions is Hong Kong.
Speaker:And so I, I'm over here at the moment listening to colleagues talk to me
Speaker:around the challenges that they face in their own professional lives.
Speaker:' Cause Hong Kong is, so if I just give it as an example, because I think
Speaker:it is relevant to the UK and beyond, it's, it's such densely populated
Speaker:area that the competition is so high.
Speaker:You know, you can have a dental practice on, you know, floor 30 of a
Speaker:building a dental practice on floor 32 and another one on floor 34.
Speaker:So it's so easy for patients to walk and move between one practice and another.
Speaker:So there is that real competitive spirit between the practices.
Speaker:So using that mechanism of complaints, be it in relation to social media,
Speaker:be it in relation to advertising, which we see particularly over here
Speaker:where it's really heavily regulated, it is very often used unfortunately
Speaker:as a mechanism for that, I suppose, competition for space in the market.
Speaker:And if you transfer that across to the uk, it's, it's definitely
Speaker:the case, probably not as, um.
Speaker:Concentrated, but we do see complaints from clinicians, uh, arising
Speaker:from the practice down the road.
Speaker:You know, it's, it's very rare that you get complaints from somebody that
Speaker:is remote from your own practice.
Speaker:Invariably, it's linked in some way to proximity and therefore,
Speaker:uh, competition for patients.
Speaker:I have definitely seen it in, uh, hospitals, apartments where there's
Speaker:been some private practice going on and there's a new kid on the block and they
Speaker:don't like, there's a sort of consortium of consultants that don't like this
Speaker:new kid on the block, and invariably within the first couple of years, a
Speaker:GMC referral will be made by one of the other consultants in the department.
Speaker:I've seen that happen quite a few times.
Speaker:it's really despicable behavior.
Speaker:It, it is.
Speaker:And, and generally speaking, the regulators don't like to
Speaker:be the battleground for these interprofessional disputes.
Speaker:I mean, as I said at the outset, it's absolutely right that some complaints
Speaker:are referred to the regulator, but I think sometimes the challenge
Speaker:lies in how easily done it is.
Speaker:You know, you can report someone now in the space of five
Speaker:minutes on an online web form.
Speaker:You press the submit button, you shut the lid of your laptop, or
Speaker:you lock the screen on your phone and you carry on with your day.
Speaker:But what you have just initiated in the, in doing that is a significant
Speaker:process that's going have a huge emotional turmoil on the recipient
Speaker:and incidentally can't be stopped.
Speaker:Once you start that process going particularly so far as the GDC is
Speaker:concerned, they will investigate it.
Speaker:You cannot wake up the next morning and think, actually, perhaps I was
Speaker:a bit hotheaded in sending that off.
Speaker:Perhaps the appropriate thing might have been to have a chat to
Speaker:this individual and ask the GDC if you can withdraw the complaint.
Speaker:The GDC will say, investigation's been opened and we need to look into this now.
Speaker:that's really quite sobering.
Speaker:And it is often very long process, isn't it?
Speaker:Isn't it?
Speaker:Can I just ask you very quickly, how quickly will they throw out okay, if
Speaker:it's obviously vexatious or malicious or malignant, you know, does it still take
Speaker:them a year to sort it out or can they like look at that pretty quickly and
Speaker:go, actually there's, there's absolutely no grounds for investigating here.
Speaker:Well, there's two answers to that.
Speaker:First of all, if I can, let me just indulge you with,
Speaker:um, my personal experience.
Speaker:So I was reported to the GDC, uh, 10 years ago, and admittedly the GDC
Speaker:is, has improved considerably in that time, and I'm not suggesting it would
Speaker:be the same time scales today, but in that situation, which related to a
Speaker:single patient that I had seen on one occasion for an emergency appointment.
Speaker:It took nine months for the GDC to write to me and tell me that I'd done nothing
Speaker:wrong and they were closing their case.
Speaker:And that was nine months at a very, you know, difficult time.
Speaker:I'd I, you know, relatively new into the profession.
Speaker:Um, you know, had just bought my new first house, got a mortgage, um, you know,
Speaker:starting to make financial commitments.
Speaker:And then ultimately you are, you are, you are facing a process that
Speaker:could lead to your avasia from the register and the end of your career.
Speaker:So that's, um, you know, you can't underestimate or understate that.
Speaker:There has been progress made.
Speaker:Um, you know, it'd be unfair of me to suggest otherwise, but we are
Speaker:still looking at cases that take a number of months, even the most
Speaker:straightforward cases to be closed at that initial triage stage.
Speaker:And if you are unfortunate enough to be in this, in the situation of a complaint.
Speaker:It goes all the, through the process to a hearing, well, hearings are
Speaker:now being scheduled well into 2026, 2027, so you are looking at years.
Speaker:If you were to get a complaint today that went to a hearing, you'd be
Speaker:looking at years, months, certainly not weeks or days for that to be resolved.
Speaker:And that takes so much of an emotional toil, doesn't it?
Speaker:We'll, we'll talk about that in a minute.
Speaker:But I guess one of the questions you'd ask us yet, would you inflict that on anybody?
Speaker:Like even if it's someone that you know, you don't like particularly,
Speaker:that, that toil and, you know, doctors, you know, speaking from my
Speaker:own experience of, of, um, luckily I've never been referred to the GMC.
Speaker:I've had complaints, but I I, I was never referred to the GMC, but I had colleagues
Speaker:that were, and yeah, it took two or three years and they were all exonerated.
Speaker:And, and even if you actually know in your head, you are
Speaker:very unlikely to be struck off.
Speaker:And the, the recent, um, numbers that I've heard from, you know, certainly
Speaker:amongst doctors, medical doctors refer to the GMC, is that most people don't end
Speaker:up in the Fitness to Practice committee unless they've been really bad, you know,
Speaker:unless they've done something criminal or they've shown absolutely no insights.
Speaker:And, and actually the reality is.
Speaker:You can make mistakes.
Speaker:Yeah.
Speaker:We all make mistakes.
Speaker:We know we do.
Speaker:And if you have some insight and you show you've learned and all
Speaker:that sort of stuff, you're very, very unlikely to be struck off.
Speaker:So in our heads, we know, you know, in your head you knew there was probably
Speaker:a zero chance of you being struck off a lot or, you know, might be suspended
Speaker:for a couple of months maybe, maybe.
Speaker:But actually you're not gonna, you're not gonna lose it.
Speaker:But it is such an emotionally difficult process and it's there in
Speaker:the back of my mind all the time.
Speaker:You know, there must be other reasons, not just am I gonna be struck up, off or not?
Speaker:For that process to be so prominent.
Speaker:And of course so many issues for doctors and dentists and other healthcare
Speaker:professionals that are going through it.
Speaker:I mean, you're, you're absolutely spot on.
Speaker:Of course you are.
Speaker:And, and I think, you know, first of all, I think you are right to say that the
Speaker:vast majority of cases will be closed without the ultimate sanction of erasure.
Speaker:It is a really tiny, tiny percentage.
Speaker:And when you look at the cases that lead to erasure, it is
Speaker:right that those individuals are removed from the register, okay?
Speaker:It's, it's right for the profession, it's right for the public.
Speaker:We not talking you.
Speaker:Isolated clinical areas, we're talking criminality and, and such serious matters.
Speaker:But you, you do go on that emotional journey.
Speaker:You wake up every morning, you go to work and you have a coffee with
Speaker:someone in the cold light today, and you, you kind of see things with
Speaker:really good perspective and you think, no, this is gonna come to nothing.
Speaker:But by the time midnight comes along and you've been sitting tossing and turning
Speaker:for three hours, you can very quickly catastrophize yourself up to, yeah,
Speaker:I'm gonna be erase from the register and this is the end of my career.
Speaker:So, yeah.
Speaker:I I, I think it's so important to keep that in mind when you make a complaint.
Speaker:And I, you know, I, I I do want to emphasize that I'm not putting
Speaker:the point here that you shouldn't escalate things to the GDC.
Speaker:Absolutely right.
Speaker:You know, there are cases where indeed you have a professional
Speaker:responsibility into not raise es and escalate concerns, you would be
Speaker:putting your own registration at risk.
Speaker:But if the matter can be effectively dealt with at a more local level, then
Speaker:that is in everyone's best interest, uh, not least the person that would
Speaker:be the recipient of the complaint.
Speaker:Do you think people just go straight to the regulator?
Speaker:Because it's the easy way to do it?
Speaker:It's the easy way out, and to me it just seems like the coward's way out
Speaker:Yeah, I, I think certainly the easy way.
Speaker:Um, certainly, you know, it, it, it takes a lot of resource to
Speaker:investigate a complaint properly, particularly those that have multiple
Speaker:patients involved or systems and process matters to be considered.
Speaker:it is helpful to have the GDC there for those, I think cynically looking
Speaker:at it to, uh, kind of take that burden on themselves and, and have
Speaker:the resource to investigate it.
Speaker:Um, I do however, think that a lot of the motivation is a lack of
Speaker:understanding, that actually you don't have to go to the ultimate arbiter.
Speaker:Let's give an example.
Speaker:You see a patient and you are, uh, a little concerned about the approach
Speaker:that the other dentist has taken.
Speaker:Okay?
Speaker:It might not be, uh, totally unprofessional, just, you know,
Speaker:you think actually not quite how I think this should have been done.
Speaker:That's not the remit of the GDC.
Speaker:The GDC is there to deal with those individuals who, you know,
Speaker:if the allegations are found, prove would not be fit to practice.
Speaker:They, they should not be the dentist, be a dentist.
Speaker:That's ultimately what you are saying.
Speaker:And it's got to be better for patients.
Speaker:It's got to be better for the profession, for those types of complaints to be
Speaker:dealt with an investigated at a local level, whether that's within the hospital
Speaker:trust department or whether that's within a particular dental practice.
Speaker:Uh, and, and I think there's two ways to support that.
Speaker:One is training.
Speaker:So having an effective training process so that everyone in the practice is
Speaker:aware of both their obligations, but also the mechanisms for escalating concerns.
Speaker:But also the need to ensure that you have a really visible process and
Speaker:you have somebody that takes ultimate responsibility for complaints handling
Speaker:or dealing with interprofessional concerns within any, any setting.
Speaker:And if you have that, then anybody with a concern, should have confidence
Speaker:in that process such that they don't feel the drive to go to the
Speaker:regulator to deal with their concerns.
Speaker:Yeah.
Speaker:The problem with that though, George, is that I hear, uh, there's a local
Speaker:expression, it's probably a national expression, secondary care doctors.
Speaker:Oh, yeah, I Datixed him, I Datixed them, and I think Datix is the reporting
Speaker:system, so it seems like, yes, the hospital thought, right, we need to
Speaker:make this way of reporting errors.
Speaker:They probably, I'm, I'm hoping it was from good motivation.
Speaker:They probably read the Amy Edmondson stuff about the, you know, the,
Speaker:the good organization reports the mistakes and errors so that they can
Speaker:learn from them and all that, but that just seems to be weaponized.
Speaker:So you Datix someone or you just, I ignore it totally because it's, it,
Speaker:it's too difficult to say anything and you think it's easier not to.
Speaker:So I think even when there are structures in place to deal with things locally, they
Speaker:either get weaponized or they get ignored.
Speaker:And so you keep putting these Datixes in and nothing seems to ever be done.
Speaker:Nothing's fed back to you.
Speaker:So then you lose confidence in the process.
Speaker:Yeah, I think that's really fair challenge on both co, on both counts.
Speaker:So, uh, you know, in in general dental practice, there are certainly, you know,
Speaker:you, you will have individual processes.
Speaker:We wouldn't have Datix process, but you are right, certainly in hospital
Speaker:trusts, Datix, uh, you know, it, it's definitely got its positive points
Speaker:because it allows individuals to raise concerns without having to have
Speaker:necessarily difficult con conversations.
Speaker:And, and let's face it, not everyone is comfortable having
Speaker:those kind of discussions.
Speaker:And okay, yes, it's still being weaponized.
Speaker:I, I concede that point, but if I was going to be a, you know, on the
Speaker:receiving end of a weaponized process, I'd much rather have to have a
Speaker:difficult conversation with a hospital manager following a Datix report than
Speaker:I would to be having to go through an investigation with the GDC or GMC.
Speaker:And I think, you know, we have to take a pragmatic approach here.
Speaker:There has to be a process in place.
Speaker:There has to be a system in place, and unfortunately, I think it's gonna
Speaker:be, uh, really difficult to get to the place where you have a system that
Speaker:is totally free of being weaponized.
Speaker:I, I should also say, Rachel, I think it's important to, to make the
Speaker:point that yes, these things do get weaponized, but we are talking, you
Speaker:know, relatively low numbers, okay?
Speaker:So the GDC clinician on clinician complaints account for less than 10% of
Speaker:concerns that land on the GDC's desk.
Speaker:And by and large, clinicians are very good, very capable and
Speaker:competent, confident to have those difficult discussions.
Speaker:You know, I will very often receive phone calls into dental protection from
Speaker:colleagues who say, actually I'm concerned about my colleague, i'm gonna go knock
Speaker:on their surgery door at lunchtime, I want to have a chat with them.
Speaker:Have you got any pointers for how to open that discussion.
Speaker:So you know it happening?
Speaker:I think we can and should do better.
Speaker:And I think really that needs to be the, the direction forward.
Speaker:If you, and I think that's really good and what's really heartening is
Speaker:that actually people can phone you up and go, what should I do about this?
Speaker:And that, is that something that the, you know, medical protections enter protection
Speaker:would really invite people to do.
Speaker:Absolutely.
Speaker:I think in any situation where you have concerns about another
Speaker:professional, we would always be happy to have that conversation.
Speaker:Now, what you are not going to get out of me, and, and I suspect my
Speaker:colleagues as well, is an answer of, yes, you need to, or no, you don't
Speaker:need to report them to the regulator.
Speaker:We we're not there to take away that decision making burden,
Speaker:which unfortunately has to sit with the individual that
Speaker:is closer to the situation.
Speaker:But what we can say is, have you tried.
Speaker:Discuss individual.
Speaker:Have you explored what mechanisms are in place in the organization you are working?
Speaker:And if you are having a conversation with us in which you're saying, look,
Speaker:there are, you know, serious concerns here that are repeating, that are not
Speaker:being resolved despite me following all those processes, then it may be
Speaker:that we say to you, well, look, you have a professional responsibility
Speaker:and you need to be mindful of that.
Speaker:And perhaps it's appropriate for you now to give consideration to,
Speaker:um, what are the mechanisms of escalation you have at your disposal.
Speaker:it is always useful to sense check stuff with a a neutral party.
Speaker:I was just thinking would you go to a colleague and talk about it first
Speaker:before you came to sort of your, your medical, protection society?
Speaker:But actually I'm thinking some, sometimes your, your colleague is
Speaker:sort of as invested as you are or as sort of can be, can feel a bit
Speaker:aggrieved as well or whatever.
Speaker:And so actually getting a very neutral perspective I think would be helpful.
Speaker:Sometimes being too close to it, knowing the personalities, and, and
Speaker:all the negative connotations that can come with, with that perspective.
Speaker:But also, perhaps a better example is, you know, we get so often now,
Speaker:colleagues will go to forums for advice.
Speaker:So they'll, they'll ask on Facebook.
Speaker:There's a very famous Facebook group with tens of thousands of dentists on.
Speaker:Now, if you seek advice there, you’ll get the whole range of answers, and
Speaker:you'll be given answers from someone who, again, can type a response and
Speaker:shut the lid of the laptop and they've got no interest in the repercussions.
Speaker:So if they say, yeah, you need to go to the GDC, then it's very easy
Speaker:to write those few words, isn't it?
Speaker:But then you are the one that then has to make those difficult decisions ultimately,
Speaker:and you get drawn into that process.
Speaker:So yeah, it, it, it's an absolute difficult balancing act and I think
Speaker:the objectivity which dental protection or medical protection can provide,
Speaker:particularly because our advice is in the best interest of the person ringing us up,
Speaker:um, can be invaluable in those situations.
Speaker:Yeah, I've certainly seen there's a very large, um, physician's Facebook
Speaker:group and yeah, someone will say, can I have advice about this?
Speaker:This is what happened.
Speaker:And people are going Report, report, report, that's awful, that's awful.
Speaker:And you're thinking, well, yeah, if you put it like that, it sounds
Speaker:awful, but there's gonna be, there's going to be context around that.
Speaker:And I, you know, I know in our own organization, you know, we're not seeing
Speaker:patients anymore, but when something has been done wrong or something happened,
Speaker:I, I used to react like, and go, well, this, this, this was wrong, this needs
Speaker:to be, this needs to be sorted out.
Speaker:Now the first thing I say is, oh, what happened here?
Speaker:Let's hear what happened.
Speaker:And The explanation always makes me feel far less serious than it, than it felt.
Speaker:So I really try and say, it's like, oh, I've noticed this.
Speaker:What happened?
Speaker:They're like, oh my word, I'm so sorry.
Speaker:And often that's exactly what you want.
Speaker:You just want somebody to be aware of what happened and a, and an
Speaker:explanation of why it happened and to know it's not going to happen again.
Speaker:And that is done much, much better with a initial conversation.
Speaker:But what I think people have trouble doing, it's raising
Speaker:it in the first place..
Speaker:It is.
Speaker:You are right.
Speaker:You are right.
Speaker:I think two reasons.
Speaker:One, it's, it's just uncomfortable, right?
Speaker:And sometimes the person you are speaking to, you will know them and,
Speaker:and they may be a, you know, difficult character, you might anticipate some
Speaker:challenges that with that conversation.
Speaker:And also I think clinicians are always mindful of what
Speaker:repercussions it might have on them.
Speaker:Um, particularly when it comes to these so-called blue on blue complaints.
Speaker:The fact that it is not uncommon, unfortunately for somebody that
Speaker:complaints about one clinician to be the recipient of a, a similar
Speaker:complaint in the other direction.
Speaker:And so I do think those challenges do muddy the water a bit and
Speaker:why getting objective support and advice could be so valuable.
Speaker:I think just to your point there, Rachel, around context being key just to kind of.
Speaker:add some illustration to that.
Speaker:I deal with cases, uh, across Asia, the UK, Caribbean and I, I have a very set
Speaker:process for how I, how I look at them.
Speaker:I would always start with the patient's complaints.
Speaker:And I'll get to the end of the patient's complaint and I'll
Speaker:think, goodness me, this is awful.
Speaker:The patient's been really badly treated here.
Speaker:And then I'll read the, the dentist or the dental professional's comments and all of
Speaker:a sudden, the mist clears and you think, ah, actually there was a reason why they
Speaker:did that, or, okay, there's some context here that actually changes my perception.
Speaker:If I could put it like this, that I think a lot of complaints raised by
Speaker:colleagues against another colleague are often given li very little
Speaker:thought and often very hotheaded in the way they're, they're sent off.
Speaker:And it is back to the point I was saying about how easy it is to raise a
Speaker:complaint on the gd, uh, GDC website.
Speaker:And my advice is really simple to any anybody that's thinking of raising
Speaker:concerns, it is extremely rare that you will come across an issue that
Speaker:has to be raised there and then.
Speaker:Very often the vast majority of cases can wait for 24 hours with zero impact.
Speaker:And so drafting an email and letting that email sit in your drafts rather than
Speaker:clicking the Send button and then going to bed and sleeping on it and coming to
Speaker:it with a fresh, you know, pair of eyes the following morning, can be invaluable.
Speaker:And the number of times I have in my professional life written an
Speaker:email, and by the way, you feel a lot better just for writing it.
Speaker:It's not the sending necessarily, and then just sitting it, you know, letting
Speaker:it sit there, come to it the next day.
Speaker:And I would say, you know, more than 50% of occasions, I then press the
Speaker:Delete button and I think better of it.
Speaker:And I, you know, have a bit more perspective and I've calmed down a little.
Speaker:So, you know, as you know, a very simple bit of advice from me would be, yeah,
Speaker:if you, if you want to raise concerns about a colleague and you're not sure how
Speaker:to do it, put your thoughts in writing.
Speaker:Don't press the Send button and then review it the next
Speaker:day and see how you feel.
Speaker:The power of the pause, right?
Speaker:When you're in that sympathetic zone, you're amygdala's going
Speaker:Oh, you gotta do something here.
Speaker:That's the time when you absolutely shouldn't do it.
Speaker:Yeah, absolutely.
Speaker:The amount of emails I haven't sent, and I've been so pleased.
Speaker:So then you wait 24 hours and you think, well actually, you
Speaker:know, I do need to either send the email or have a conversation.
Speaker:I, I'm thinking a conversation would be far better than an email, if possible.
Speaker:Is that right?
Speaker:I think it's because I think, um, a lot of tone gets lost in email and
Speaker:communication is only small parts, what we say, and a large part of body
Speaker:posture, gestures, facial expressions.
Speaker:And I think, you know, when you are communicating something like that,
Speaker:having those additional cues to support the communication are so important.
Speaker:But having said that.
Speaker:If you then do not feel that your concerns have been properly listened to
Speaker:or acted upon, then having it in writing is really helpful, because if you are
Speaker:later criticized for not dealing with it appropriately, having that record,
Speaker:that audit trail of what you said, uh, is, is is also of great importance.
Speaker:And the way I would advise kind of ticking both of those boxes is it doesn't hurt
Speaker:to have the conversation and then to just gently say at the end of the conversation,
Speaker:so, perhaps it'd be easy for both of us, you know, to help both of us out.
Speaker:If I just summarize what we've agreed and I'll pop it in an email to you.
Speaker:Um, it's a nice way of kind of tying someone's hands to an action, but
Speaker:also providing that audit trail.
Speaker:Would you advise giving them a bit of a warning shot, like saying
Speaker:in an email, um, can I pop over?
Speaker:I've got just some concerns about this patient, or someone came to see me and I
Speaker:just wanna understand a bit more, or would you just leave that til you see them?
Speaker:That's a really good question.
Speaker:Now, my personal view, I hate emails that say, can I have a word?
Speaker:Yeah.
Speaker:You worry
Speaker:you just think, oh, what is it?
Speaker:Yeah.
Speaker:So I, my personal, if I'm the recipient, I would just rather you rip the plaster
Speaker:off, walk in my room and say, I need to talk to you about this and this.
Speaker:I think if you are gonna give someone a, a warning, a advance notice in an
Speaker:email, because that can be helpful.
Speaker:It can give, you know, if you wanna to talk about something specific.
Speaker:So let's say you wanna talk about a particular patient, I think absolutely
Speaker:can be helpful to give them the notice so they can go and review those records.
Speaker:They can remind themselves of the patient and you can have a
Speaker:more constructive discussion.
Speaker:Because otherwise what you are gonna get when you knock on their door is,
Speaker:look, I can't remember the detail, give me some time to read the records.
Speaker:And you're just kicking the can down the road when you've gone to that
Speaker:room, having built up the courage to have that difficult conversation.
Speaker:But what I would say, just, just to be kinder is give
Speaker:enough information in the email.
Speaker:You know, you, you can say, look, I've saw, I saw Mr. Smith this
Speaker:morning, had some concerns around his appointment with you last Tuesday.
Speaker:Have you got some time later on today to discuss it?
Speaker:So there's no, there's none of that kind of cloak and daggers, you know, I want
Speaker:to have a word about something serious and you don't tell them what it is.
Speaker:I just, I juts think it’s, uh, my personal view is.
Speaker:It's just a kind way of dealing with people.
Speaker:It's interesting though, I think people avoid having these conversations,
Speaker:and you've already mentioned that when you, when you're talking to
Speaker:another colleague going, oh, you know, how should we feed this back?
Speaker:Oh no, they'll take it really badly or whatever.
Speaker:Well, we often really assume that that person is gonna be defensive, they're
Speaker:gonna take it badly, they'll be a real arsehole when, when we feed back to them.
Speaker:But, uh, my colleague Sarah always quotes that we overestimate the negative
Speaker:impact of having a conversation and we underestimate the negative impact
Speaker:of not having that conversation.
Speaker:I think that's absolutely right and I think, you know, clinicians in general
Speaker:are really invested in their own abilities and their own performance,
Speaker:and they are keen to know when they are, you know, not doing something.
Speaker:Now, a lot of this conversation has naturally kind of drawn towards
Speaker:the, the sinister motive side.
Speaker:You know, we've got someone, you know, some really bad and we've gotta
Speaker:have a really difficult conversation.
Speaker:But actually, if it is something, let, let me think of an example.
Speaker:Let's say receptionists has noticed that all the patients coming out of,
Speaker:uh, my surgery are saying that they feel like I didn't take the time
Speaker:to welcome them into the surgery.
Speaker:Now, to somebody that might be a difficult conversation to go and speak.
Speaker:'cause I might be quite a bullish character, I might be quite dismissive.
Speaker:But equally, I might be totally oblivious to this.
Speaker:And if somebody says to me, actually, George, you, we've had a couple of
Speaker:patients that just happened to mention that they quite like the way that the
Speaker:previous dentist, uh, used to welcome into the surgery and offer, you know,
Speaker:to take their coat or I, I dunno, ask them how their day's going or
Speaker:how their holiday was or something.
Speaker:And that might give me the opportunity to say, oh, yeah,
Speaker:no, I hadn't thought of that.
Speaker:I, my my impression was that patients want to be in and out as quickly as
Speaker:possible, and that's why I'm rushing.
Speaker:It's not because I'm rushing, it's because I think that's what the patient wants.
Speaker:I'm really pleased you brought this to my attention and I'll do that in future.
Speaker:So it's, it's probably not the best example, but you, you know, it, I
Speaker:think it's fair to say that, you know, the vast majority of clinicians are
Speaker:insightful, are keen to develop and would prefer to have these kind of
Speaker:blind spots brought to their attention.
Speaker:Yeah.
Speaker:And I always think that feedback.
Speaker:It's a total gift and we don't get enough feedback.
Speaker:And this is one of my real bug bears at the moment.
Speaker:Um, we teach a model of difficult conversation having framework
Speaker:for difficult conversations called the High Five model.
Speaker:And the High in the High Five model stands for highest intent.
Speaker:And you were talking about the fact that, you know, we have been assuming
Speaker:a, a a lot of the conversations we've had that you know, that the person's
Speaker:bad or they've got some malicious, either intent by complaining or the
Speaker:doctor or dentist being complained about is lazy or, or something like that.
Speaker:And that is just hardly ever the case, isn't it?
Speaker:You know, there are some bad eggs in the basket, but mostly people are
Speaker:overwhelmed, they're stressed, they're, you know, struggling with work.
Speaker:And we had, um, Dr. Chris Turner on the podcast recently talking
Speaker:about, you know, what to do when you are the difficult person.
Speaker:And he said he does a lot of appraisals.
Speaker:He's the founder of Civility Saves Lives movement.
Speaker:Does a lot of appraisals.
Speaker:And he sort of gets given the people that are, have been complained about or, or,
Speaker:or seem to be difficult characters or, or lazy people have thought they're lazier,
Speaker:not really doing their job properly.
Speaker:And he said, you know, in all his time of seeing these people
Speaker:that not one of them is lazy.
Speaker:It's other, there's other factors at work.
Speaker:They're getting to be burnt out.
Speaker:There's just too much going on, there's difficult interpersonal
Speaker:relationships, all that.
Speaker:And so most of us go to work to do a good job, don't we?
Speaker:And most of us, when we are raising complaints about other people or
Speaker:notice that something wrong are doing it because genuinely we are
Speaker:worried and concerned about the treatment that patients have had.
Speaker:So if both of you think about your highest intents in that conversation,
Speaker:so why am I having this conversation if it is vexatious and malicious 'cause
Speaker:their, their competition for me in my practice, well, a, I won't be thinking
Speaker:about what highest intent anyway, i'll just be doing despicable things.
Speaker:So let's exclude that Lot of people.
Speaker:They'll be thinking, well, what do I want out this conversation?
Speaker:I just want some feedback so they don't do it again.
Speaker:Or feedback so that they're aware or just understand more, then that
Speaker:has got to be quite a good way of, of going into the conversation.
Speaker:And, and even would you advise stating it?
Speaker:So just saying that I just wanted to, to check something out.
Speaker:'cause something, something happened, I've noticed something
Speaker:and I was just a bit worried.
Speaker:I just want to flag it up in case you hadn't seen it and just check
Speaker:in with you about what was going on and just understand what happened?
Speaker:just so that I'm clear that we are both working to the best of our
Speaker:ability or, or something like that.
Speaker:Yeah.
Speaker:And what I would say is that I think these so-called difficult conversations,
Speaker:and they, and they are, I'm, I'm not, I'm not minimizing that, but.
Speaker:It does get easier.
Speaker:And I think the more that you have those difficult discussions with
Speaker:your colleagues, the more it will become almost a, a casual, you
Speaker:know, chat over the water cooler.
Speaker:So it, it's, it becomes, uh, for both parties, uh, a conversation
Speaker:of much less significance.
Speaker:I don't mean by that, that it gets dealt with any less, uh, seriously, it is just
Speaker:that it's in the rear view mirror of both parties a lot quicker and you're not
Speaker:dwelling on it for the rest of the day.
Speaker:Did I say the right thing?
Speaker:How's it been received or the recipient's thinking you know, I feel totally outraged
Speaker:that they've come to me with this.
Speaker:And I think what can really help that is it's, it's part of a broader culture piece
Speaker:and that involves offering the positive as well as the negative feedback, and I think
Speaker:that is something that in clinical dental practice, we are particularly poor at.
Speaker:If a patient goes to see someone and let's say that the usual dentist
Speaker:is on holiday and they say, uh, you know, I normally see George, and by
Speaker:the way, George is lovely, you know, he was, he always puts me at ease.
Speaker:I've always struggled with going to the dentist, but I finally found
Speaker:someone I feel comfortable with.
Speaker:Then I would say, make a note of that really quickly.
Speaker:And then when George gets back from holiday, go and knock on his door
Speaker:and say, have we got two minutes?
Speaker:I saw Mrs. Smith last week.
Speaker:She said You were lovely.
Speaker:Um, she said, you've really put her at ease and you know, she feels much more
Speaker:comfortable coming to the dentist now.
Speaker:And you'll make that person's day.
Speaker:You will feel better for it.
Speaker:And it then means that when you need to go and have the difficult conversation,
Speaker:you've got a much better relationship of, uh, exchange of feedback with them.
Speaker:Because, you know, in a sense, positive feedback is, uh, also a difficult
Speaker:conversation because you are still having to use all of those communication tools,
Speaker:um, learn to go and interact with your peers, sometimes senior colleagues.
Speaker:Uh, so I think it's all good in terms of building up that skill base.
Speaker:Yeah, and sometimes we don't have those positive conversations
Speaker:'cause it feels awkward.
Speaker:You are right.
Speaker:They are still challenging conversations.
Speaker:Like, oh, does it feel a bit icky to tell George that his patient
Speaker:thought he was really good?
Speaker:But I think we just start, need to start thinking of feedback as data.
Speaker:This is some data.
Speaker:George, we've got some data for you.
Speaker:The patients like it when you do this.
Speaker:Yes.
Speaker:Yeah.
Speaker:I've also got some data for you that they don't like it when you do that.
Speaker:Yes.
Speaker:Yeah.
Speaker:And then it's up to the recipient, what they do with that data.
Speaker:Um, and I think that's the really important piece because, you know, it,
Speaker:it in the context of raising concerns to another clinician, you know,
Speaker:there's, there's two phases to it.
Speaker:One is imparting the information and there are certain situations where it's
Speaker:then over to them and, and you, I suppose to a point, your, uh, responsibility
Speaker:is discharged at that point of parting, you know, handing that over.
Speaker:An example might be the one I gave about not welcoming to the surgery.
Speaker:Now that's not something that you can, again, knock on the GDC's door with.
Speaker:It's not something that in necessarily you're gonna lose any sleepover.
Speaker:It's just good negative feedback.
Speaker:It's just, here's a heads up, here's something you could do that's gonna
Speaker:cost you nothing, take no time, but will apparently have an impact on
Speaker:your patients and how perceive you.
Speaker:Over to you.
Speaker:Now, you may choose not to start welcoming your patients in the way that's been
Speaker:suggested, or you may choose to totally overhaul how you are interacting with
Speaker:your patients when they walk in the door.
Speaker:That's a matter for you.
Speaker:And that is, uh, well that's why I love the data point, because feedback
Speaker:is just an exchange of information.
Speaker:And then how it's acted upon is, is a, a totally separate se uh, level.
Speaker:Now, there will be occasions just to kind of go back to the, the more serious side
Speaker:of the spectrum where actually you are, you are invested in that data and how
Speaker:it's used, and you have to follow it up.
Speaker:It isn't enough to say, we've had reports from a couple of patients
Speaker:that you're not putting gloves on before you clinically examine them.
Speaker:And then that's it.
Speaker:I'm not gonna do anything.
Speaker:You then, of course, need to make sure the, the feedback's been acted
Speaker:upon and, and something's been put in place, uh, to, to make sure
Speaker:that's been properly addressed.
Speaker:And if it hasn't, that's the point at which you might wanna be picking
Speaker:up the phone to us and taking advice on how you escalate those concerns.
Speaker:Yes, I was gonna ask that.
Speaker:So what.
Speaker:Happens if you know someone continues doing that thing, you, you fed back to
Speaker:them about you've had that conversation.
Speaker:I heard a phrase the other day that a mistake made more than once is a decision.
Speaker:I thought, oh, that's interesting.
Speaker:Although, I must say I made mistakes more than once all the
Speaker:time, you know, unknowingly.
Speaker:But yeah, if, if you've had that behavior fed back to you and you've decided to keep
Speaker:doing it, then you do have to escalate.
Speaker:So what advice would you be giving if I phoned you up and said, right.
Speaker:I've had the conversation.
Speaker:They weren't particularly receptive.
Speaker:They were a bit defensive about it, and, and it's happened again.
Speaker:Well, let's take it as a given that, uh, everyone listening has done the first
Speaker:stage, which is to make sure you've got an effective process in place, okay?
Speaker:So if you don't have that in place, then it makes this bit very difficult
Speaker:because following on from the difficult conversation and putting
Speaker:it in writing, as I've uh, suggested previously, is to escalate it in-house.
Speaker:So that might be clinical director, it might be practice manager,
Speaker:might be practice principal.
Speaker:But whatever setting you are working in, there will be a hierarchy to some extent.
Speaker:There'll be someone with whom the buck stops, and you can
Speaker:escalate your concerns to them.
Speaker:My suggestion at that point is put it in writing.
Speaker:You want an audit trail.
Speaker:You want to be able to evidence that you have executed your professional
Speaker:responsibility appropriately.
Speaker:Thereafter.
Speaker:it's helpful to monitor it.
Speaker:You, you know, of course there will be situations where you are not entitled to
Speaker:know how things are dealt with and it, nor would it be appropriate and, and the
Speaker:conversation ends at you escalating it.
Speaker:But there will be circumstances where if you think patients are
Speaker:being put at risk, you do want to monitor how that's being dealt with.
Speaker:And if after escalating in a local setting as far as you can, you find
Speaker:that nothing is being done, then it is at that point that you definitely do
Speaker:need to start to consider escalating your concerns to the regulator.
Speaker:But I, I would say three things before you do that.
Speaker:First off, you would be really well advised to speak to your indemnify,
Speaker:and as I've, as I've already said in dental protection, medical protection,
Speaker:um, we would be more than happy to have that conversation just to sense
Speaker:check and, and often actually, rather than sense checking what we're doing is
Speaker:just exploring with you other options.
Speaker:Um, not necessarily saying which one to take, we're just giving you the
Speaker:menu so that you can make your choice.
Speaker:Uh, and then I would say really read the guidance.
Speaker:The GDC and the GMC all have, both have their own guidance
Speaker:on escalating concerns to them.
Speaker:The types of things they deal with, um, and the types of things they don't.
Speaker:And then the third one, uh, which again I've alluded to is just take a breath.
Speaker:There's, there's very little that you need to deal with absolutely there and then.
Speaker:Even pretty serious stuff, you can go and have a cup of tea and sit down for half
Speaker:an hour just to compose your thoughts.
Speaker:And then, you know, if, if you are left with the conclusion that it's
Speaker:appropriate to raise it to the GDC, then you have to, of course, act as you
Speaker:think is professionally appropriate.
Speaker:It's then a matter for you how you deal with it, with the individual.
Speaker:I, I've seen it happen both ways.
Speaker:I've seen individuals get, uh, complained about where the first they knew about
Speaker:it was a letter from the regulator.
Speaker:and I've had a case very recently where actually the directors of the
Speaker:practice wrote to the individual and said, just a heads up that we
Speaker:have had to refer this to the GDC.
Speaker:This is the information we've given them.
Speaker:We're very sorry that we've had to do this, but hope you'll appreciate the
Speaker:difficult position that we were placed.
Speaker:Um, it, it's then a matter for you, the individual, how
Speaker:you choose to approach that.
Speaker:There's no right or wrong.
Speaker:I think it depends on the relationship that you have.
Speaker:But, but really I would say in a practice setting where, unfortunately because of
Speaker:the management structures, invariably the person that you are complaining
Speaker:about, you know them personally, you're very close to them by, by kind
Speaker:of nature of, of, of the proximity, you work with them in the practice.
Speaker:And so, you know, you can be the good and the bad guy.
Speaker:You can say, look, we've had some really difficult
Speaker:conversations, nothing's changing.
Speaker:We have a professional obligation, we've had to raise this to regulator,
Speaker:but second part to that, appreciate that's really difficult and we want
Speaker:to support you through the process.
Speaker:And here's some signposting to support.
Speaker:And you know, I know that could be seen as disingenuous.
Speaker:I know that could be, uh, not particularly well received by, uh,
Speaker:the individual, but if you are raising concerns for the right reasons at the
Speaker:right times for the right things, then I don't see it as totally unreasonable
Speaker:for those two to go hand in hand.
Speaker:Then you can be good and bad copying one.
Speaker:Yeah, I totally agree.
Speaker:But the problem I'm thinking about is that obviously a lot of our listeners
Speaker:are gps and they're dealing with patients that have been seen by secondary.
Speaker:care.
Speaker:And so they are spotting issues that have happened in secondary care or secondary
Speaker:care spotting issues that's happened in general practice, and it's much, much
Speaker:harder these days to pick up the phone and have a conversation with that person.
Speaker:So, although it's not impossible, would you still be saying, look,
Speaker:just see what you can do to actually speak to that person?
Speaker:Yeah, I, I would, to be perfectly honest with you, um, I, I absolutely
Speaker:take your point about primary secondary care, proximity challenges.
Speaker:Um, and we see that a lot as well in, uh, dental practice, for
Speaker:instance, between general dentist and specialists, perhaps an orthodontist.
Speaker:A really good example is where a dentist has taken the wrong
Speaker:tooth out and they're blaming the orthodontist 'cause it was written
Speaker:wrong on the referral and vice versa.
Speaker:And actually, based on my experience over the last 10 years of dealing
Speaker:with these cases, the ones that are dealt with much more efficiently, much
Speaker:more effectively for the patient, the patient gets the best outcome, the
Speaker:clinicians get the best outcome are the cases where the two.pick the phone
Speaker:up to each-other and talk it out.
Speaker:Now, the caveat to that is that you can only go so far with that, can't you?
Speaker:And you, you know, busy practices and sometimes difficult to get
Speaker:contact details and you want to maintain professional boundaries.
Speaker:So yeah, I get there are all sorts of challenges to that approach,
Speaker:but wherever possible, I'm a huge advocate for just, um, sitting
Speaker:two people in one room and bashing their heads together to sort it out.
Speaker:And 9 times out of 10 you can do that.
Speaker:Yeah, and I always think, well, what would I want if I was that person?
Speaker:So, you know, if I was that, um, surgeon secondary care, the GP's noticed a
Speaker:mistake or something with bedside manner and you know, it, it really needs
Speaker:addressing, I would much rather have a phone call and say, look, I just can, I
Speaker:just wanted to talk to you about this.
Speaker:I thought it might be useful feedback for you, whatever, then, then hear
Speaker:about it the first time through.
Speaker:Either the regulator or through the hospital official liaison
Speaker:complaint, complaint process.
Speaker:But it's hard, and it may be that I need to talk to colleagues about
Speaker:that and approach it together and discuss with, you know, the colleagues
Speaker:about how, how best to do that.
Speaker:You know, I think with the best one in the world, even if someone has really,
Speaker:um, explained why they're escalating and things like that, you're, you
Speaker:still might feel quite pissed off or you'd feel very upset about it.
Speaker:I mean, we're not talking about the, the minor stuff.
Speaker:You have a conversation.
Speaker:Oh, yeah, okay.
Speaker:I noticed I was a bit grumpy that day.
Speaker:Yeah, I, I can change that.
Speaker:But we have made a big, a big error.
Speaker:Someone said, actually, we are gonna need to escalate this.
Speaker:And they have complained about you.
Speaker:That is, I. Really difficult on all sorts of levels.
Speaker:Firstly was the fact there's a complaint going through.
Speaker:We talked about that earlier.
Speaker:But secondly, that interpersonal level, I think I would be feeling a lot of
Speaker:shame, a lot of embarrassment, and we know that actually when people feel
Speaker:shame and embarrassment, then that often comes out as defensiveness and, and
Speaker:arsiness and actually I could be then behaving quite badly towards that person.
Speaker:And I'm sure you've seen that as well.
Speaker:So what do we do when it, when it's us?
Speaker:great question.
Speaker:I think first of all, if it's somebody knocking on your door,
Speaker:coming to speak to you, recognize how difficult that's been for them
Speaker:Yeah.
Speaker:The courage it would've taken, right?
Speaker:Yeah, absolutely.
Speaker:And recognize that the alternative options were up to and including
Speaker:reporting you to the regulator.
Speaker:So as far as possible, deal with it constructively, recognizing that because
Speaker:the more you do that, the more they will come and knock on your door the
Speaker:next time, and the more you will have the opportunity to address these things
Speaker:at a very local level without all the unnecessary stress of that escalation.
Speaker:But also just take time out to reflect rather than going with the
Speaker:instinctive response because, you know, I think dentists and doctors,
Speaker:we are naturally high achievers.
Speaker:We're so used to going through a, you know, very rigorous educational pathway
Speaker:that has driven us to become these almost robotic, individuals that cannot
Speaker:possibly face any challenge or criticism.
Speaker:And I, I know for one, you know, I, I used to, um, receive feedback really badly.
Speaker:I'm, I'm probably still not great.
Speaker:I still naturally err on the very defensive side, but I'd like to think that
Speaker:I have driven myself to get better at it.
Speaker:And my personal approach now is to just take some time out and, and
Speaker:really force yourself to look into the uncomfortable parts of your professional
Speaker:life and really, you know, reflect on the feedback you've been given and
Speaker:think actually, have they got a point?
Speaker:And you don't necessarily have to agree with feedback in order to accept it.
Speaker:Do you, if you go back to the data point, you know, you, you can receive
Speaker:it, you can thank the individual for it, and then you can store it
Speaker:away in a metaphorical draw and not necessarily do anything to act upon it.
Speaker:Because some feedback will be, you know, if we use my example earlier,
Speaker:if the patients don't like the way you're greeting your patients, some
Speaker:patients might love that, or some patients might come to you because
Speaker:you are a little bit less small talk and you get on with things.
Speaker:So you might decide actually, well that's fine.
Speaker:If they want to have that, they can go and see you.
Speaker:You know, that's the benefit of the fact we both work here and I'll
Speaker:stick with doing things my way.
Speaker:I've got no issue with that.
Speaker:And I think that's important that you recognize that not all
Speaker:feedback needs to be acted upon.
Speaker:But also I think.
Speaker:Having that courage to alter your approach and to, to think okay, yeah.
Speaker:Uh, feedback from my, uh, nurses, for example, that I'm abrupt in how I speak
Speaker:to them, um, I've now had that feedback.
Speaker:It's on me to, from this point forward, make a real conscious effort to fix that.
Speaker:And you mentioned earlier before about, two mistakes being, uh,
Speaker:intentional, and that's me paraphrasing your words, but also a lot of
Speaker:clinical practice is habitual.
Speaker:You know, if you've been in practice for 20 years, you will be able,
Speaker:you'll have a particular patter.
Speaker:You know, I remember I used to say to patients the same phrases we'd moan about
Speaker:the weather, my nurse would roll her eyes because it's, God, I've hear, I've
Speaker:heard this script 30 times today already.
Speaker:So to change that, to change that approach based on that
Speaker:feedback, is really difficult.
Speaker:So don't expect instant results either.
Speaker:Um, but be prepared to work at developing and improving.
Speaker:And if that means, you know, an a, a criticism of your clinical practice, be
Speaker:prepared to go and go on a course, do some CPD, you know, address those shortcomings,
Speaker:maybe work with the person giving you the feedback to see how they can support you.
Speaker:'cause if they are supportive enough to knock on your door and have that
Speaker:difficult conversation, then I'd bet some decent money, they'd be happy
Speaker:to support you to address it as well.
Speaker:I think the phrase that's coming to me is that feedback is a total gift.
Speaker:So you're right.
Speaker:If that person is taking the time to do that, then they've, they've stepped
Speaker:up to do it and you need to listen.
Speaker:Uh, the problem is, just like you said, in, in medicine, it's
Speaker:all about are we perfect or not?
Speaker:And you know, the way that we've been trained, you gotta get every single answer
Speaker:right, every single diagnosis right, and never fail and never get anything wrong.
Speaker:And so when you are, when you get the, the, the data that actually you have done
Speaker:something that's caused other people pain, possibly or, or suffering or distress, a
Speaker:you feel really bad 'cause you don't wanna ever call anyone cause anyone suffering
Speaker:or make a mistake, so there's that like, oh no, I've done harm to somebody else.
Speaker:Or That's not worse.
Speaker:There's that.
Speaker:But then there's the shame of, gosh, I'm not good enough, I'm not enough.
Speaker:And when you've been judged all your life by what you produce,
Speaker:what you do, how good you are, then that's really hard to cope with.
Speaker:And, and then the first thing we tend to do is become very, very defensive
Speaker:and try and explain why we did it.
Speaker:And I remember when I would get complaints, the first thing I'd just look
Speaker:back and make sure it wasn't my fault.
Speaker:Make sure I didn't do anything wrong.
Speaker:That's all well and good, but actually what if I had done something wrong?
Speaker:I need to be able to tolerate it when I am in the wrong because I know I can change.
Speaker:But we really struggle with that.
Speaker:We do.
Speaker:And, and I think what we need to do is normalize mistakes and
Speaker:normalize complaints, and try to remove some of the stigma.
Speaker:And I think the dentist that tells you they don't get a
Speaker:complaint, it's one of two things.
Speaker:Either they're lying or they don't have an effective process
Speaker:in place to capture them.
Speaker:One thing that I've noticed as well is, um.
Speaker:my instinct would be if someone comes to tell you about, gives you some
Speaker:feedback, like, okay, well let's, let's just keep this very confidential,
Speaker:but thank you for telling me.
Speaker:And you know, I'll change whatever.
Speaker:But actually when I have shared stuff that's gone wrong, times where
Speaker:I think I've really mucked up, when I've had negative feedback and stuff,
Speaker:it's made me feel so much better.
Speaker:And I ended up, I end up now sharing it on the podcast with thousands of people.
Speaker:But it's so helpful.
Speaker:Brene Brown says, shame cannot survive being spoken.
Speaker:So the minute you tell someone about the mistake you've made or the feedback
Speaker:that you've got, it just dissipates.
Speaker:'cause everyone goes, oh yeah, that's helpful.
Speaker:Yeah, what you gonna do?
Speaker:And gosh, that happened to me.
Speaker:And interestingly, in all, all the emails we get from people about the podcast,
Speaker:it's mostly saying, oh, when you told that story about when you mucked up,
Speaker:oh, that made me feel so much better.
Speaker:And it, it really, really does.
Speaker:It's uncanny, isn't it?
Speaker:It's, it is, and, and the the same is, you know, it's absolutely true of, you
Speaker:know, things like adverse incidents.
Speaker:So I will often, uh, lecture, you know, newly qualified dentists and I'll say,
Speaker:you know, two weeks into my foundation year, um, I was drilling a patient's tooth
Speaker:and the bur came outta the handpiece and disappeared down the back of their throat.
Speaker:Um, and it was a terrifying moment for me as a dental,
Speaker:uh, a newly qualified dentist.
Speaker:But instantly you can just see that almost the relief from those
Speaker:in the audience as they realize.
Speaker:Oh, right, okay.
Speaker:And you survived.
Speaker:Um, and I think that's a really nice point to kind of bring in is, is, you
Speaker:know, my, my GDC experience, which I've spoken about for me, really was to
Speaker:springboard to a really fruitful career.
Speaker:It opened my eyes to the world of indemnity.
Speaker:It opened my, uh, eyes to NPS and dental protection and the great work that they
Speaker:did to support me through that process.
Speaker:Um, and ultimately I'm convinced that it is ultimately what got me a job
Speaker:with them doing the work that I do now, supporting other dentists, because
Speaker:the empathy that you get from going through the process is invaluable.
Speaker:And so if I was to meet the chap that complained about me now to the GDC,
Speaker:I'd probably buy him a drink and shake his hand and say, thank you very much.
Speaker:But the serious point is he never got an apology from me.
Speaker:He never got a refund, and he never got an explanation of why the
Speaker:treatment I provided was appropriate and why, to put it bluntly, he
Speaker:was wrong to raise his complaint.
Speaker:It was misunderstanding, miscommunication.
Speaker:It wasn't bad treatment.
Speaker:Him going to the GDC achieved absolutely nothing.
Speaker:He had to wait nine months for an answer.
Speaker:I had to wait nine months for an answer.
Speaker:And if he'd come to the practice directly, he would've got an apology.
Speaker:He'd have got a refund because, you know, I was, you know, very keen and
Speaker:still am on, you know, building goodwill.
Speaker:And if it's, if, if that's what it takes to keep someone happy, then I, then I
Speaker:will, even if I've done nothing wrong.
Speaker:So he'd have got a lot out of that.
Speaker:And instead, by going for that nuclear option, that opportunity was missed.
Speaker:Now, he didn't have the benefit of being aware of all the local
Speaker:processes that we have, but anyone listening to the podcast, working in a
Speaker:healthcare role, will know what those local measures are in the processes.
Speaker:So really it's a gift to go through those local process.
Speaker:You get much more out of it than going to the regulator, because the regulator
Speaker:is a very cold process that actually I think even the complainant doesn't win.
Speaker:You know, it's, it, it doesn't really get anyone anywhere.
Speaker:Save them, as I say, just to, to drive that point home that there will be
Speaker:certainly cases that that need to go there and I'm not minimizing that.
Speaker:The annoying thing about being complained about is that that's
Speaker:where you learn the most.
Speaker:That's where you developed the most.
Speaker:That's where, you know, I looked through in my careers.
Speaker:It's either where things that have not worked or failed or negative
Speaker:feedback that I've got where I've actually learned and changed the most.
Speaker:And that's a really annoying thing about like self-awareness
Speaker:and personal development.
Speaker:You don't develop if everyone's telling you how wonderful you are.
Speaker:You do when they start telling you, well that could have been done
Speaker:better, or that was a bit rubbish, or this is how it made me feel.
Speaker:So it is a real gift, even if the person doesn't respond like
Speaker:it's a real gift at the time.
Speaker:Before we finish quickly, George, do you have any other tips for what
Speaker:people can do themselves when they are dealing with a complaint that's
Speaker:either gone to the regulator or going through sort of official channels?
Speaker:'Cause it's such a, a difficult and anxious and uncertain time.
Speaker:So what would you be advising your, your members to do as well?
Speaker:I answer it more how I'd say, you know, advise a friend over coffee.
Speaker:So, if a friend of mine came to me and said, look, George,
Speaker:I've, I've got this going on.
Speaker:I, I would say three things.
Speaker:First of all, I would say take some time out to focus on yourself.
Speaker:It might be you take a week of leave.
Speaker:You know, if it's as bad as you know, a GMC or GDC complaint, you know
Speaker:that's only gonna happen at worse one or two times in your career.
Speaker:So it's a really significant event.
Speaker:Put yourself first, take some time out.
Speaker:Secondly, speak to people about it.
Speaker:There is absolutely no reason why.
Speaker:We need to bottle these things up.
Speaker:It is not the career ending calamity that we will initially think it is.
Speaker:And so having the opportunity to draw on that, uh, support
Speaker:network is really important.
Speaker:And thirdly, I would say keep perspective.
Speaker:So, um, my back of a napkin calculation, if you see, uh, 30 patients a day,
Speaker:five days a week, 48 weeks a year for a 30 year career, you're gonna see
Speaker:in the region of quarter of a million patients or patient interactions.
Speaker:Now, if you have in your career 10 serious complaints, you've still got
Speaker:249,990 happy patient interactions.
Speaker:So, you know, it's really important that when you get that Christmas card or that
Speaker:gift or the thank you notes, I say keep them, put them on display, and then have
Speaker:a box or a draw that you put them in.
Speaker:So when you get to those really low points, um, you can open the
Speaker:drawer and just be reminded that actually this is a single event.
Speaker:This is not you, and how it defines you as a clinician.
Speaker:that.
Speaker:So see it as a significant event if you do get, you know, a serious
Speaker:complaint and yeah, and, and take the time that you need to deal with it.
Speaker:Yeah, I love that about talking to people.
Speaker:Get people on your side.
Speaker:'cause if you, as soon as you share it, it takes a sting out of it.
Speaker:It really, it really does.
Speaker:It might be difficult the first time, but then, uh, you'll feel, and you
Speaker:will find that people are really, really supportive of you as well.
Speaker:Generally people are, aren't they?
Speaker:They're like, oh, thank God that didn't happen to me.
Speaker:What can I do to support you?
Speaker:Yeah, I remember, I remember telling my boss when I got my GDC letter and
Speaker:I built up the courage to walk in, um, at lunchtime to speak to my boss.
Speaker:And I walked in thinking, this is just gonna open the doors to the second
Speaker:tranche of, you know, negativity.
Speaker:I've had the letter and now I'm gonna get sacked or suspended or whatever.
Speaker:And, um, actually my boss just gave me a hug, you know, we had a
Speaker:very close friendship and said, I'm really sorry that you've had that.
Speaker:It seems really unfair.
Speaker:And they were from that point on right through the
Speaker:process, incredibly supportive.
Speaker:So the error I made was presupposing how they would deal with it.
Speaker:And I suppose the knock onto that, the, the, the, the point that I, you know,
Speaker:it'd be great to use this opportunity is if you have a colleague that's in receipt
Speaker:of a complaint, yes, they sound serious.
Speaker:A complaint to the regulator is serious, but just remember that it
Speaker:doesn't define them as a clinician.
Speaker:It's part of a bigger story.
Speaker:There's always context, and first and foremost, I think as any colleague would,
Speaker:would want to, um, support them, you know, leave the, the regulators to make the
Speaker:judgements, and you just be there as a friend and colleague to help through it.
Speaker:we had someone on the podcast who was talking about a, a patient who died
Speaker:by suicide, and they felt incredibly guilty and lots of people were very
Speaker:supportive, but the one thing that made the difference to them was their
Speaker:boss saying that happened to me.
Speaker:And they went, oh, that was the one thing, oh gosh, it wasn't just me.
Speaker:'Cause you feel like, oh, I'm dreadful.
Speaker:It was just me.
Speaker:So sharing, being vulnerable, telling people your story
Speaker:can all be really helpful.
Speaker:George, that's been really helpful and if people wanted to of contact you or
Speaker:find out more about the work that the Dental Protection Society or Medical
Speaker:Protection Society does, you know, where would you, or they want more stuff around
Speaker:this, where would you point them towards?
Speaker:Okay, so they can go to our website, which is dentalprotection.org
Speaker:or medicalprotection.org.
Speaker:They can access that from any country that we operate in.
Speaker:And we have country specific sites.
Speaker:On there, there is a wealth of information and resource, including access to our
Speaker:e-learning platform, which has a range of webinars for the benefit of members.
Speaker:So I'd encourage anyone with an interest, uh, to have a look on there.
Speaker:If anyone wants to get in touch with me personally, if they've, they've enjoyed
Speaker:hearing about my experiences, um, then they can contact me via LinkedIn.
Speaker:So I'm available on LinkedIn, um, or via the Dental Proection pages.
Speaker:Great.
Speaker:So we'll pop all those notes in the show notes and I think we are going to be doing
Speaker:some, some webinars, um, in association with the Dental Protection Society and
Speaker:Medical Protection Society soon as well.
Speaker:So if you remember, keep an eye out for that.
Speaker:Um, we'll also make a download of the High Five conversation model available in
Speaker:the show notes just in case anybody wants to look further into that and explore
Speaker:how they might be able to use that.
Speaker:So George, thank you so much for being on.
Speaker:It's been really, really helpful.
Speaker:Um, and I'm, I'm certainly gonna bear a lot of that in mind.
Speaker:Uh, if I ever have to, you know, complain about a doctor myself or a dentist or
Speaker:whatever it is always, always better to have the conversation go locally and don't
Speaker:escalate unless you absolutely have to.
Speaker:Yeah, absolutely.
Speaker:Thanks for having me, Rachel.
Speaker:Thanks for listening.
Speaker:Don't forget, you can get extra bonus episodes and audio courses along with
Speaker:unlimited access to our library of videos and CPD workbooks by joining
Speaker:FrogXtra and FrogXtra Gold, our memberships to help busy professionals
Speaker:like you beat burnout and work happier.
Speaker:Find out more at youarenotafrog.com/members.