Artwork for podcast You Are Not A Frog
How to Survive a Complaint from Another Clinician
Episode 2788th July 2025 • You Are Not A Frog • Dr Rachel Morris
00:00:00 01:07:28

Share Episode

Shownotes

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.

Get more episodes and resources by joining FrogXtra

Mentioned in this episode:

FrogXtra Gold
Join the Frog podcast community

FrogFest Virtual – The Boundary Hunters
Tuesday 25th November

Transcripts

Speaker:

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.

Links

Chapters

Video

More from YouTube