Health: Be gentle with me, patient

WE HEAR a lot about rude doctors (see the main article on this page) but rather less about rude patients. Yet the capacity to hurt, insult and offend is not confined to one side of the surgery desk.

Patients can make their doctors' lives a misery just as doctors can negatively affect their patients, and in our increasingly complaining culture, opportunities for doing so are growing.

A snapshot of the effect this is having is provided by a disturbing study of 30 GPs in one area of south London who had had to deal with a complaint from a patient.

The doctors describe the traumatic effect of the complaint on their confidence, their clinical judgement and their professional pride.

They reacted variously with shock and panic, a sense of indignation towards all patients, anger, depression and even, in some cases, attempted suicide. The complaints triggered doubts about their clinical competence and conflicts with family and colleagues.

Two anecdotes encapsulate the response. One GP said that patients now regarded doctors like a supermarket.

"If patients don't like something, they complain, and you get this ethos that patients are `entitled to this' and `entitled to that'," he said. "Patients' attitude is now: `If you don't give it to me, I will complain or I will see my solicitors.'"

Another doctor expressed her sense of disappointment and defeat: "Sometimes I wonder why I go out of the way to help all my patients: just do a short consultation and that's the end of the matter.

"I just feel it's a waste of time trying to help because when it comes to the complaint, whatever good you have done is all wiped out by the complaint."

Management experts counsel us to learn from our mistakes but what is distinctive about these GPs is how, for them, the experience of receiving a complaint was almost universally negative. Few managed to construe the complaints in a positive light, as opportunities for improving their practice, although one of them did say that he regarded every complaint as a "treasure".

The British Medical Journal, which published the study last week, observed that the GPs responded by becoming more defensive in their practice and offering a less appropriate service. As its editor, Richard Smith, notes: "This is a chilling study, because it seems likely that in the future most doctors will have complaints made against them."

Doctors have been knocked from their pedestals, certainly. Patients are taking a more equal role in determining their care and in questioning what doctors advise and prescribe.

But along with these healthy developments has grown a blame culture in which intimidating those who make mistakes has taken precedence over the spirit of teaching and learning in which complaints ought, ideally, to be made and received.

Dr Smith suggests failure is a greater taboo than sex or money. Doctors - all of whom have known the success of getting into and graduating from medical school - have great difficulties with failure.

He cites Winston Churchill who regarded success as "the ability to go from failure to failure without losing your enthusiasm." It is useful advice for doctors - and for the rest of us.