Are you amongst my 35 loyal readers who have found my TripAdvisor reviews helpful? Have you armed yourself with my latest incisive review of the Red Mullions guest house in Oxford – Baby for Breakfast? In my 15 reviews in 4 years, I lurk behind my mask as ‘themacrae’ so I am that dread figure – the anonymous reviewer with the freedom to publish on the internet and to be rude without the risk of discovery or consequence.
A recent TV programme highlighted the plight of the owners of small hotels and B&Bs alleging that their businesses were crippled by poor reviews on sites like Trip Advisor and by threats of blackmail – ‘Give me my money back or I publish this stinker of a review on Trip Advisor or similar’. And now we are hearing about GPs and their resentment at the postings of the dissatisfied, vindictive and above all anonymous patients who post rude and insulting comments. In the two years since the launch of the service, there have been almost 29000 comments about 6667 GP practices. 2000 comments from patients have been removed by moderators with a similar number of GP comments suppressed as well on much the same grounds. Knock about stuff and the question is – does it help improve service? Do people have enough confidence in this information to do something with it to make things better?
Geeks go to war
You do not have to spend much time on the internet to see how quickly an exchange can escalate with the language becoming very violent and abusive – often disproportionately so as mild-mannered computer geeks each hiding behind their own nom de guerre go off the deep end, contributing to such well-established feuds about Apple vs Windows. The abuse can be deeply unpleasant and personal and the emotion totally disproportionate to the issue at stake. Teenagers at war – typing at the speed of light completely outpacing any capacity for reflection and thought. The Apple Corporation and Microsoft live with this. They are large bureaucracies with customer response departments, PR agencies and if it comes to it lawyers and investigators to track you down. Take a look at the forum on Amazon where customers sound off – yodel indeed – about a particular delivery company. This is pure, raw and priceless user feedback.
Bad News – This Time It’s Personal
In my experience, it is the smaller business which reacts most ferociously and for entirely understandable reasons – after all it is often their business and one that is much more vulnerable to criticism – if you are a small B&B with a 4 month season and 10 bookings a week and critical comments coming in high season losing you 20 bookings are v bad news. GPs are small businesses albeit ones that are sheltered to a degree from the market place, and they often react in much the same way, raging about comments that are in their view contemptible, unsubstantiated and unhelpful. These small businesses lack the cooling effect of large stodgy bureaucracies that can absorb and filter the emotion and take out the personal sting when problems arise. In the NHS context, hospitals with their dedicated complaint staff should be able to run complaint handling at a lower emotional temperature (but see our report My Anger Propelled Me ). However they can – or the staff in them can – strike back in a way that presses the fear button amongst all patients.
Consequences for Complainants
A post on the Patient Opinion blog has a horrifying story:
A call to Patient Opinion from someone with a serious long-term condition, a longstanding user of services at a well known teaching hospital. The patient had had a poor experience at one of the hospital’s clinics. They sent in a written complaint, but received no response, so after a month they posted their story on Patient Opinion.
It wasn’t long before the phone rang. It was a member of staff at the hospital, who refused to give their name. The patient was told: “Withdraw your complaint, or we will withdraw care.”
Time for a deep breath. Anonymity is a sign of a dysfunctional system where it would appear that the parties in the system are equally scared of one another. Anger is a sign of fear and helplessness and the stronger those feelings, the more toxic the exchange. Talking about the fear of consequences, I always liked the story of the supermarket who wanted to encourage consumer feedback instore and especially on their new speciality butchery department where skilled butchers were on hand to advise and deal with customer problems. All you needed to do was pick up the phone next to the meat display. Not a peep. Why? – nobody fancied the risk that they would end up mixing it with a large man wielding a large cleaver fresh from dismembering some hapless animal out the back. It is the same syndrome in hospitals where patients may wait till they are safely home before voicing their dissatisfaction.
Complaints can have consequences and with GP practices, that includes being struck off the list and threats of withdrawal of care. Anonymity protects from those consequences but it does allow the ordinarily meek and mild to play the foul-mouthed ogre and spray insults and prejudices into the virtual world, enjoying the irresponsibility that comes with being able to escape the consequences.
Is there a solution? Well this may sound impossibly low key but for what it is worth, the best thing is just to keep reading this stuff. Get past the insults and see the patterns and the needs being expressed by patients. Look at your own reaction. What is it that is pushing your buttons? Instead of speculating about the twisted motivations of those toads of patients issuing all this bile, look at why you are so angry? Take a leaf from the tenets of Nonviolent Communication and connect with yourself. Let some light and air into the problem and publish the stuff in the surgery newsletter; ask patients ‘is there anything else you wanted to raise with me today?” Make the transmission of concerns a risk-free exercise with positive outcomes. No one says you cannot set your own boundaries and refuse to listen to the foul-mouthed or intemperate but at least take a moment to reflect on the reasons behind this behaviour. If all else fails, there is the option for GPs of striking off all patients and enjoying a quiet life.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We work with complaint handlers to achieve user satisfaction and recommendation.