Every year at Guild Insurance, the veterinary liability claims reported to us are analysed to ensure we fully understand what clients are complaining about, what’s going wrong and what can be done to address this. 

The information below provides a summary of what’s been learnt from this process.  Unfortunately, the best risk management practices can’t guarantee a complaint won’t occur, that’s why you need insurance.  However, being aware of common complaints, and how to reduce the likelihood of them, is something all vets should be aware of.

Why clients complain

Treatment has been unsuccessful – this is when the treatment hasn’t gone to plan, and the outcome isn’t as intended.  This is most commonly seen following de-sexing procedures.  Clients are often not only unhappy about a poor outcome but can also be motivated to complain due to a sense their time and money has been wasted.

Treatment was inappropriate – this means it’s alleged there’s been a poor outcome because the treatment shouldn’t have been provided. This may be because the treatment selected was an incorrect choice or that the vet should have referred to someone else to provide treatment.

Diagnosis issue – a client might complain if they believe the diagnosis, and therefore the treatment which followed, was incorrect.  Or they might think it took too long to form the correct diagnosis.  Generally in these cases the client’s unhappy with the time and money spent during the diagnosis phase and the potential harm to their animal during this period.

Medication error – common medication errors include the animal receiving an incorrect dose, the animal receiving the incorrect medication, or the medication being administered incorrectly. Generally medication errors are due to human error where the vet has made a simple, but at times serious, mistake.

New injury – this is when the animal has suffered an injury during treatment.  Common examples of this include an organ being damaged during surgery or an animal (horse or cattle) suffering a rectal tear during an examination.

Tips for reducing complaints

Communication – don’t underestimate the importance of communication with clients and colleagues; our claims tell us that breakdowns in communication contribute to complaints.

Manage expectations – if clients have unrealistic expectations, those expectations most likely won’t be met, and the client won’t be satisfied.  An important part of communication is ensuring clients understand what the likely and realistic outcomes of treatment will be.

Informed consent – another key part of communication is ensuring clients understand treatment options, treatment outcomes and potential risks so they can give their informed consent to treatment.  Clients should also be made aware of the anticipated cost of treatment so they can give their informed financial consent.

Clinical decision-making – it’s important to not rush the assessment, diagnosis and treatment selection process.  When the necessary time and care isn’t taken, assumptions and mistakes can be made.

Record keeping – keeping detailed records of all aspects of treatment, as well as any communication with the client, assists with the continuity of care of the animal over time. Detailed records will also assist in the defence of an allegation of wrongdoing.

Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791. This article contains information of a general nature only, and is not intended to constitute the provision of legal advice. Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them.

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You said what? Appropriate conversations in chiropractic

Complaints of wrongdoing against chiropractors isn’t always about the treatment provided or the clinical outcome.  Guild Insurance sees numerous cases annually which relate to the professional behaviour and conduct of a chiropractor.  This sort of complaint may initially seem less serious than those relating to poor clinical outcomes, however, having your professional conduct questioned and issues raised about inappropriate behaviour towards patients can be incredibly distressing. 

Some of these professional conduct complaints relate to conversations, both during and outside of the consultation.  Once investigated, it’s usually found that the chiropractor in no way intended to breach any professional boundaries or make the patient feel uncomfortable.  However this is what’s occurred.  The information below has been created to assist chiropractors understand what they should be doing and saying differently to avoid facing a complaint similar to the following examples.

Examples of inappropriate conversations

• A patient complained alleging the chiropractor made them feel uncomfortable by asking questions about being a single parent.The chiropractor claimed it was only done to understand more about the patient’s lifestyle, however the patient felt judged by the chiropractor.
• A patient complained of feeling uncomfortable as the chiropractor lowered the patient’s pants during treatment without consent.Following investigation, it was found the treatment provided and lowering the patient’s pants was, in this instance, clinically justified.However, distracted by a chat they were having about weekend activities, the chiropractor forgot to continually talk to the patient about treatment and didn’t seek the patient’s informed consent before moving clothing.
• A patient complained about questions the chiropractor asked about dating.The chiropractor claimed the conversation was just intended as a friendly chat, however the patient felt the chiropractor was trying to initiate an intimate relationship.

Tips about professional conversations

• Don’t become too friendly with your patients.While it’s clinically beneficial to build a rapport with patients, a professional boundary needs to be maintained.And this boundary means there are conversations you would have with a friend or family member which you shouldn’t have with a patient.Conversations should be had in a professional manner so avoid becoming too casual, relaxed or jokey when talking to patients.Often comments made in light humour, or to build rapport, can lead to difficult situations and potentially embarrassing accusations or reputation damaging conditions on your registration.What may be funny to you may not be to someone else.The relationship with a patient should always remain a professional one; keeping in mind the patient is paying for a healthcare consultation not a social chit-chat.

• Limit non-professional or non-treatment related conversations. These types of conversations can easily complicate and confuse a professional situation.When a practitioner asks personal questions of their patient, this is most likely intended to just be a friendly chat.However patients often report being confused and uncomfortable and don’t understand why they’re being asked questions not related to treatment.While some conversations may be fine, such as asking how a person’s weekend was, things can easily change when more questions are asked, such as about the partner they spent the weekend with.
• Explain to patients why questions are being asked. If you do need to ask some personal or lifestyle questions to assist with history taking or to better understand an injury or pain, be careful to explain why you’re asking.
• Don’t forget to keep talking about treatment.When non-treatment related discussions are had, this detracts from time which should be spent discussing treatment.The discussion about treatment shouldn’t just be had at the beginning of the consultation, it’s an ongoing conversation throughout.Not only can chats about something other than treatment make a patient feel uncomfortable, it may also mean the patient isn’t fully informed about their treatment.
• Consider the situation of the patient during a conversation.During treatment, patients are often sitting or lying in positions which may make them feel vulnerable or exposed.Personal conversations had during this time are likely to compound the uncomfortable feeling.Keep in mind a patient could easily misinterpret the intentions behind your questions or conversation if they’re already feeling uneasy.
• Consider the method of communication. SMS, email and other forms of electronic communication encourage brief messages and don’t often adequately convey the full intent or tone of the message.Therefore, if communicating in this way, practitioners need to be mindful that patients may easily misinterpret the message and make assumptions.Also, don’t forget that electronic communication, as with all communication with a patient, needs to form part of the clinical record for that patient.

Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791.  This article contains information of a general nature only, and is not intended to constitute the provision of legal advice.  Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them.

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Receiving a complaint is an unexpected part of running any business. No business is immune from receiving a complaint, regardless of how successful it is or how customer focused staff are. There can be a tendency to see a complaint as a personal criticism rather than constructive feedback. However there can be positive outcomes when the situation is managed appropriately.

Why do people complain?

There are many reasons why patients might complain about the service they’ve received. Sometimes a complaint will almost be expected following an incident; sometimes it will take you by complete surprise. Understanding why people might complain can assist with managing a complaint if it occurs and potentially reducing the likelihood of further complaints.

The following are some of the reasons why people may feel the need to complain.

High expectations – consumer expectations are increasingly high when engaging professional services. Your patients will see you as a highly trained and qualified professional. This view can influence their expectations about the service and outcomes they anticipate.

Unrealistic expectations – it’s possible that patients may have unrealistic expectations about what they can reasonably expect from the services you provide. It’s therefore important to remember that most patients will not have the clinical knowledge you do and what’s obvious or common sense to you may not be to them. A practitioner must assist patients to be clear and informed about the services being provided and the outcomes they can realistically expect.

To inform and be heard – patients may wish to make a complaint about an incident or poor outcome simply to be sure someone’s aware of what’s occurred and how they feel. They may wish to complain just to be listened to and acknowledged, especially if they’ve been adversely impacted. Not all complaints will lead to a formal demand for compensation.

Belief that someone is responsible – when something goes wrong, we often try to determine who’s responsible. Sometimes someone is obviously responsible, sometimes it’s hard to determine who’s responsible and other times there’s no one person responsible but just an unfortunate set of circumstances. However, if a patient thought something had gone wrong and this led to them being harmed, it’s quite possible they may complain with the intention of holding someone responsible.

The importance of managing complaints

There may sometimes be a temptation to ignore a complaint and hope it’ll just go away. Maybe the patient won’t follow up. Maybe the incident won’t occur again. This is a very short-sighted way to run any business as there are clear benefits to appropriately managing complaints.

Patients will generally expect to see their complaint dealt with quickly and fairly. When this doesn’t happen it’s possible that further complaints will follow, and the issue or concern could become a much greater one. Complaints may also escalate to Ahpra or another regulatory body.

Complaints can provide a business with an opportunity to review and improve their service. Receiving a complaint may highlight an issue which the business hadn’t been aware of. When investigating and dealing with the complaint, the business may wish to consider a change in procedure to avoid that issue arising again in the future.

How to manage complaints

It’s advisable that every business has a complaints policy. This means that the business will have an agreed-to process for dealing with a complaint which allows for
all complaints to be managed in a fair and consistent manner. It also means staff know
what to do which is important as managing complaints can be a quite challenging.

A key aspect in dealing with any complaint is listening to the person. Where possible, make time to sit down in a quiet space and give them time to express their concerns.
Make the effort to hear what they have to say and take on board what they’ve told you. You may not agree with all they’re saying, however it helps if you can try to understand the situation from their perspective. You may wish to ask them to document their concerns so you both have an accurate record of the matter. Avoid being defensive or taking the complaint personally as this may inflame the situation.

With low level complaints you may be able to offer a solution there and then. However, this won’t always be the case. With more serious complaints you should provide the person with an assurance that you’ll investigate the matter and get back to them with a response at a later date. Guild Insurance expects those insured with us to not admit liability (or name someone else as being at fault), or to offer any compensation without
contacting us first. Contact Guild Insurance on 1800 810 213 as soon as you’ve received a complaint; don’t wait till it escalates to a claim for compensation. We’ll provide advice and support to assist you to deal appropriately and professionally with what can be a challenging and possibly upsetting situation. Utilising this support can be the difference between sorting a problem quickly and it escalating to a serious claim.

Managing complaints in radiography