The shame of patient complaints

Martin Billington is a Sheffield GP, appraiser, educator and podcast host

Here’s a quick exercise for you: Imagine you are on a day off, or maybe it’s the weekend. You’re not at work. For some reason, which of course you later regret, you check your work emails. There is an email from your practice manager with the subject title “Patient complaint.”

Most of us have been there. Spend a minute or two now to consider what thoughts and feelings you are having. Maybe even write them down.

I wonder how many of you have responded with, “I feel 100% confident in myself as a clinician and medical professional and I look forward to seeing how this complaint can help me learn more about how patients relate to me as a GP. It will be an interesting developmental process.” Probably not that many.

In contrast, I wonder how many of you imagine feeling panicky, anxious, stressed, worried, angry, regretful and scared. Maybe thinking to yourself “Well this is it- the career ending moment when everyone realises, I’m a fraud. I’ll definitely get suspended, probably struck off and there’s a good chance I’ll be going to prison too.”

I imagine most of us would find ourselves in the latter camp.  Not surprisingly we don’t tend to respond healthily when we perceive that someone is saying, “You’re not good at your job”.

I believe that behind all the anxious feelings and self-critical inner narrative is a powerful emotion that rarely gets discussed; shame. We hold ourselves to such high standards that, for many of us, complaints and criticism get to our very core. Research by the Medical Protection Society suggested that almost 1 in 3 doctors under GMC investigation have contemplated taking their own life.^¹

Crucially it’s the involvement of other people in complaints which makes them so shaming.

We imagine what the patient is thinking, how their family feel about us, perhaps how our colleagues might judge us and with what wrath the GMC will condemn us. The truth is rarely as bad as what our catastrophic imaginations torture us with.

Some of us may have first experienced shame as learners. I still palpably remember being unfairly humiliated by a shouting senior doctor on a hospital ward decades ago. I can still picture his face, his vehemence, the other staff and students who witnessed it.

It has been suggested to me that shame is so powerful because it stems for a primitive fear of being rejected by our tribe, cast out to try to survive alone in a dangerous world.

Though similar, shame is different from guilt. With guilt, we know we have done something bad. We can apologise and hopefully move on. With shame however our pervasive thought is “I am a bad person”. Most of us identify so closely with our role as doctors, that if someone complains about us at work, what we may hear is, “You are bad at being you.”

There are more conversations about perfectionism in our profession nowadays, and I suggest it is a fear of shame that drives our perfectionism. If we can be perfect doctors, no one will ever criticise us and we won’t have to hold the awful emotion of shame in our lives. Of course, we all rationally know this can’t be true, we can’t be perfect, but we aren’t always rational, and our emotions certainly aren’t.

Is a life without shame, shameless? Well, that doesn’t sound good either.

So, if we don’t want to be shameless, how do we live with our shame? We could try and bury it; good old-fashioned repression of emotion. I believe this then hugely influences our behaviours, our relationships and our mood. We might practice more defensively; we may treat, investigate and refer more. We may become resentful, introspective, unhappy.

A healthier approach would be to bring it into the open and talk it out. We all need safe relationships to which we can bring these difficult conversations and be heard through with empathy, non-judgement and support. Dr Sandy Miles, a GP with a special interest in shame, speaks wisely on the subject in a well-known medical podcast and in quoting Brenee Brown advises “talking about shame cuts it off at the knees”.^² Brown identifies four key components of shame resilience: recognizing shame and understanding its triggers, practicing critical awareness, reaching out to others, and naming shame.³

I started a new salaried GP post relatively recently and was floored to receive several patient complaints in the first six months. I felt awful, embarrassed, shamed. I lost a few nights sleep; a weekend away was ruined by my anxious imagination. What would my new bosses think of me? “Who is this psychopath we have employed?” Did I already have a bad reputation within the patient group? It unusual for me to get so many complaints, I might expect one every 2 years or so.  But I could not deny the angry patient letters, the long cross emails. I approached two trustworthy GP friends and bared my soul. They listened, they comforted, they asked helpful questions. I told the GP partners and manager how I felt and apologised. They were supportive and reassuring, appreciating my honesty. I reflected on my approach with patients and my communication style, and I made a few changes. Nothing has come of any of the complaints, I have not been struck off, I sleep well, I am still in post. Though I am still rather phobic of work emails.

References:

1. theguardian.com/society/2023/apr/27/almost-one-in-three-doctors-investigated-by-gmc-have-suicidal-thoughts [accessed 20/5/25]
2. Rachel Morris and Sandy Miles, How Perfectionism and Shame Lead to Stress and Burnout, You Are Not A Frog Podcast, Episode 152, 24th January 2023,  https://youarenotafrog.com/episodes/152/ [accessed 20/5/25]
3. Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead by Brenee Brown, published by Penguin, 2012.

Featured photo by Gift Habeshaw on Unsplash.