Patients and doctors can often have different expectations of treatment outcomes.
The reasons for this are varied, but understanding the difference in perspectives is key.

As well as arising from actual shortfalls in medical care, complaints can also relate to concerns about other non-clinical issues, or the patient's perception that something went wrong - when in actual fact, from the clinician's perspective, the care was good.

A clinician will tend to view successful care in terms of clinical outcomes, but patients are much more likely to place importance on other factors. These can include the emotional impact of the experience, or whether or not they feel cared about and cared for by the clinician.

Remember that complaints aren't always made directly to those providing care. Patients may choose to involve other organisations such as the GMC, the ombudsman, the coroner or the police, which can trigger investigations with potentially serious outcomes for the doctor.

Why might patients see things differently?

Too much information

Patients might attend their doctor with a preconception of how they will be treated, which could be for a variety of reasons.

Websites patients have viewed might be inaccurate, or aimed at patients from other countries where the medical care may be different.
Patients might expect investigations or treatment currently unavailable in the UK or on the NHS.
They might base their expectations of the experiences of friends or relatives whose clinical scenario may have been different (such as expecting antibiotics for a sore throat).

Lack of information

Patients may not have been appropriately informed about what to expect. They could have unrealistic expectations about things like waiting times, private practice fees or complications of treatment.

Contradictory advice

A patient might be seen by different clinicians for the same problem. Without a proper understanding of medicine, they may view uncertainty about diagnosis or treatment, or inconsistent advice, as indicating that one or more of their doctors is wrong.

Anxiety

If patients are anxious when they see a doctor, this can compound the factors above and make misunderstandings more likely.

Things can be particularly difficult with the NHS under pressure and patients attending feeling frustrated even before you've consulted with them.

Time pressures

Short appointment times can mean it's difficult to spend enough time talking to a patient to check they fully understand the issues involved in their care, whether diagnostic uncertainty, complications of treatment, or different treatment options.

Minimising the risk

There are a number of practical ways you can try to maximise patient satisfaction while also minimising the risk of a complaint arising.

Provide information in other ways

Clear information on your website, on answering machines, and posters in waiting rooms can all help patients know what to expect.

This is particularly useful to ensure patients know how long consultations are scheduled to last, how long they should allow for a prescription to be generated, opening times, fees for services and so on.

Communicate in a way the patient can understand

Remember that each patient is different, and will have different needs and levels of understanding. Try to avoid medical terminology, abbreviations and jargon, and with the patient's permission, involve those close to them in the discussion where possible.

Check understanding and let the patient ask questions

There are many reasons why a patient might have difficulty absorbing what you say. You can check they have understood by politely asking them to repeat what you've said, and you may wish to offer a further appointment to go through things again. Patient information leaflets or information about extra resources can be very helpful for the patient to read at home.

You may also want to ask patients what their experiences are during consultations, so that this can be addressed as part of shared decision-making.

Show empathy and understanding

Establishing a good rapport and professional relationship with your patient goes a long way to gaining their trust, and as a consequence, improving their experience of their care.

Be open to feedback

Developing an informal, non-confrontational way for patients to discuss concerns or leave feedback can allow you to address any issues in full, and hopefully avoid escalation to a formal complaint. This might also help you to make any changes that can improve patient confidence in the care you provide.

Summary

Patients and doctors will always have different perspectives, but being aware of this will mean you can anticipate concerns and prevent them from arising, which can improve patients' confidence in the care you provide.

Providing informal opportunities for them to discuss their care also lets you reassure them, manage their expectations and build trust. You might find they are valuable resource for your practice.

Managing patient expectations

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