Patient complaints in general practice seen through the lens of professionalism

Background Professionalism is a key competence for physicians. Patient complaints provide a unique insight into patient expectations regarding professionalism. Research exploring the exact nature of patient complaints in general practice, especially focused on professionalism, is limited.

Aim To characterise patient complaints in primary care and to explore in more detail which issues with professionalism exist.

Design & setting A retrospective observational study in which all unsolicited patient complaints to a representative out-of-hours general practice (OOH GP) service provider in the Netherlands were analysed over a 10-year period (2009–2019).

Method Complaints were coded for general characteristics and thematically categorised in themes using the CanMEDS framework as sensitising concepts. Complaints categorised as professionalism were subdivided using open coding.

Results Out of 746 996 patient consultations (telephone, face to face, and home visits) 484 (0.065%) resulted in eligible complaint letters. The majority consisted of two or more complaints, resulting in 833 different complaints. Most complaints concerned GPs (80%); a minority (19%) assistants. Thirty-five per cent concerned perceived professionalism lapses of physicians. A rich diversity in the wording of professionalism lapses was found, where 'not being taken seriously' was mentioned most often. Forty-five per cent related to medical expertise, such as missed diagnoses or unsuccessful clinical treatment. Nineteen per cent related to management problems, especially waiting times and access to care. Communication issues were only explicitly mentioned in 1% of the complaints.

Conclusion Most unsolicited patient complaints are related to clinical problems. One-third, however, concerns professionalism issues. Not being taken seriously was the most frequent mentioned theme within the professionalism category.