How do you make a complaint about the Ombudsman, asks one reader?
Re: Care culture needs to change (interview with Ombudsman Emily O'Reilly, Health Supplement, May 9th)
How do you make a complaint about the Ombudsman? Well, after reading her interview in the recent Irish Times Health Supplement, I tried.
I spoke to one of her colleagues. He asked me to consider that she had little control over how she is represented in an interview and sent me her recent report on Complaints against the Public Health Service. I have read the report and see much that is positive, particularly the Statement of Good Practice in dealing with patients. However, my original questions remain.
First, let me state a conflict of interest: I am a hospital consultant. I see ill patients every day. I try to cure or manage disease in so far as I can. Sometimes, the course of an illness leads to a patient dying and my priority is to alleviate suffering and allow somebody to die with dignity.
Along the journey of any one person's illness, I spend a great deal of time communicating with the patient and his/her family. This involves explaining illness and treatment, trying to predict likely outcomes, and - occasionally - delivering bad news. In the course of any one week, any one doctor will have many interactions with patients and relatives.
Although the medical scenarios may be familiar to us, we are aware that they are strange and frightening to patients.
It sometimes happens that, despite our best efforts, the outcome does not lead to recovery. In such situations, the ongoing conversation we have with patients and their families can be strained as they express their disappointment.
Sometimes things go wrong and patients have reason for complaint. Before such formal complaints materialise, there may be meetings with families and patients, correspondence, second opinions and an investigation by our risk management departments.
All along this process, we are involved. Such complaints represent a tiny proportion of the many thousands of interactions each consultant has with patients and relatives throughout any one year. Most of these interactions are positive in outcome and receive no publicity. Only the doctor and the patient will know.
It was against this background that I was surprised to read the views of the Ombudsman regarding medical complaints. She made a number of indiscriminatory generalisations and assumptions regarding doctors. It appears she makes these assumptions based on "only 20 complaints to the Ombudsman regarding Irish hospitals last year". Her comments would have you believe that she has canvassed the opinion of every health service user in forming her opinions and not based them on 20 complaints.
We are told that she "has rarely found that health professionals, particularly doctors and consultants, engage wholeheartedly with patients' complaints" and that "medical staff invariably see complaint-handling as a matter for administrators".
How confident can she be of this assertion? If even one consultant has over a thousand interactions in any year, have all these interactions been scrutinised?
Before any complaint materialises, there may be many meetings and letters between doctors and patients and relatives in wards and outpatients. Only in a few cases will this process evolve into a formal complaint as the interaction may satisfactorily address the patient's concerns. These cases are not representative of all interactions and it is dangerous to draw generalisable conclusions from them.
Of course, improvements are necessary in our handling of complaints. Doctors communicate poorly at times - as do solicitors, journalists and, dare I say, Ombudsmen. However, extrapolating the experience of a small number of cases on to all doctors is reductionist and dangerous. It demonstrates that rather than acting as an impartial adjudicator in the field of medical complaints, the Ombudsman appears to have prejudices based on limited experience.
The Ombudsman says "senior doctors see themselves as independent republics". This blanket statement may, of course, apply to some doctors, but it may also apply to Ombudsmen who equate the experience of all those who need to complain about the health service with the experience of the thousands of patients treated each year who have no cause for complaint.
If this is the Ombudsman's "calling card", as she puts it, then I would like to return it with a request for the number of the person I should contact if I want to be judged fairly. Number please?
Dr Colm Henry is a consultant physician in geriatric medicine in Cork.