Dealing with Errors & Complaints

SJT Textbook: Dealing with Errors & Complaints

Dealing with Errors and Complaints MSRA

This guide acts as your central hub for Dealing with Errors and Complaints MSRA scenarios. In the Professional Dilemmas paper, you are tested on your ability to navigate the aftermath of a mistake, moving from immediate patient safety to long-term system learning.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Dealing with errors and complaints means responding openly and constructively when things go wrong or patients raise concerns. Safe doctors focus first on the person affected: they apologise, check for harm, and make sure the situation is clinically safe.

It also means understanding governance: duty of candour, complaints pathways, incident reporting, and how learning is captured in morbidity and mortality meetings, PSIRF reviews, and local QI. You are honest about what happened, avoid speculation or blame, and record a clear factual account.

The SJT tests whether you disclose in a timely and compassionate way, escalate appropriately, preserve the integrity of records, and turn incidents into meaningful change. High-scoring answers protect the patient, are transparent, and show learning; low-scoring answers hide, minimise, falsify, or blame.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Offer a prompt, sincere apology that acknowledges distress and outlines what you will do next.
2. Assess for immediate and potential harm; stabilise the patient and put safety measures in place.
3. Escalate to an appropriate senior and initiate local processes (incident report, PALS/complaints) without delay.
4. Explain the plan and likely timelines for investigation and follow-up, checking understanding.
5. Document a factual, contemporaneous account including what happened, what was said, and actions taken.
6. Reflect and participate in learning or QI to reduce recurrence (personal learning and systems changes).
7. Offer appropriate support to staff involved and escalate if they appear too distressed to practise safely.

Trap answers minimise, conceal, delay or shift blame instead of apologising, protecting, escalating, and learning.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I have informed my consultant and completed an incident report so we can investigate and prevent this happening again.”
* “You are entitled to raise a formal complaint; PALS and our complaints team can support you with this process.”
* “I will document what has happened and when we will update you, so there is a clear record of our plan.”
* “As a team we will review this at our governance meeting and agree specific changes to reduce the chance of recurrence.”

Apologise • Protect (assess harm) • Escalate • Xplain next steps • Learn (document and improve)

📋 QUICK FAQ

Do I apologise before the investigation is complete?
Yes. You should apologise promptly for what has happened and any distress caused, share what is known so far, explain that an investigation will take place, and commit to keeping the patient updated.

How do I avoid blaming individuals?
Focus on facts, timelines, contributory factors and systems. Avoid speculation and personal criticism; let formal processes determine accountability. Use the language of “we” and “the team” where appropriate.

What must go into the record?
A factual account of what happened, when it was discovered, who was informed, what you told the patient, the apology given, questions asked, agreed plan, incident report details and any immediate risk-reduction steps.

Who handles the complaint formally?
The clinical response sits with you and your senior; the formal complaints process is coordinated by PALS or the complaints department. You should contribute information but not bypass the established process.

How do I support colleagues after an incident?
Offer space to talk, encourage breaks and debriefs, signpost occupational health or wellbeing services, and escalate to seniors if their distress affects safe practice. Avoid gossip or blame.

📚 GMC ANCHOR POINTS

* Be open and honest with patients when things go wrong, including offering an apology and explaining what will be done to put matters right (GMC Good medical practice 2024).
* Follow the joint GMC/NMC guidance on candour: openness and honesty when things go wrong, including notifying your organisation.
* Make clear, accurate and timely records of significant events, discussions and decisions (GMC Recording information).
* Raise concerns where patient safety, quality of care or organisational culture prevent learning from incidents (GMC Raising and acting on concerns).
* Participate in systems of quality assurance and quality improvement, including incident reviews and audits (GMC Good medical practice 2024).

💡 MINI PRACTICE SCENARIO

A patient on your ward received another patient’s clinic letter with confidential details. They are understandably upset and worried about their own data. They are clinically stable. Your registrar is in theatre and not immediately available. The ward clerk suggests simply taking the letter back and reprinting the correct one.

Best action: Apologise and acknowledge the breach, check for any further impact, explain that you will inform your senior and the relevant governance teams, initiate an incident report, advise how the patient can raise a formal complaint if they wish, and document the discussion and plan.
Why: This approach fulfils duty of candour, protects trust, and routes the issue into proper governance and learning, rather than minimising or concealing it.

🎯 KEY TAKEAWAYS

✓ Apologise early, sincerely and specifically for what happened and the distress caused.
✓ Stabilise the clinical situation and mitigate ongoing or potential harm.
✓ Escalate promptly to seniors, PALS/complaints and incident reporting systems.
✓ Keep clear, factual, timely records of events, discussions and decisions.
✓ Focus on learning and system improvement, not quiet fixes or blame.
✓ Support colleagues involved and escalate if they are too distressed to practise safely.

🔗 RELATED TOPICS

* → Raising Concerns and Whistleblowing
* → Handover, Documentation and Record-Keeping
* → Professionalism: Probity and Honesty
* → Duty of Candour and Open Disclosure
* → Teamwork, Debriefing and Governance

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

A 64-year-old man with heart failure receives a discharge summary addressed to another patient, including their diagnosis of cancer. He brings it back to the ward visibly upset and says he has lost confidence in the hospital. He is haemodynamically stable. The ward sister asks you to “just sort it out quickly” as the ward is busy.

Options:
A. Take the incorrect letter, quietly print the correct one, hand it over without mentioning the mistake, and move on.
B. Apologise for the error and distress, explain what is known, and check whether he has any immediate clinical concerns.
C. Inform your consultant and the nurse in charge, and complete an incident report describing the breach of confidentiality.
D. Tell the patient that “these things happen everywhere” and that he is overreacting.
E. Explain the trust’s complaints process and that PALS can support him if he wishes to raise a formal complaint.
F. Alter the electronic record so it looks as if the wrong letter was never printed.
G. Document the event, your apology, the information shared, and the plan for follow-up in the clinical notes.
H. Tell the patient that the ward clerk is responsible and that you will make sure they are disciplined.

Example SJT — Rank 5 (best → worst)

A medication error is discovered on the ward: a patient received double the intended dose of a non-opioid analgesic due to a prescribing error. They are currently well with normal observations. The nurse who administered the drug is tearful and worried they will be “struck off”. Your consultant is in clinic nearby.

Options:
A. Reassure the nurse that you will help, assess the patient for harm, inform the consultant, apologise to the patient, complete an incident report, and arrange appropriate monitoring and follow-up.
B. Check the patient is stable, tell the nurse not to worry, and suggest that there is no need to inform anyone as “no harm has happened yet”.
C. Document the error in the notes and incident system, debrief briefly with the nurse, and agree to discuss learning at the next governance meeting.
D. Tell the patient there has been a minor error but minimise its importance and do not mention incident reporting to avoid “making a fuss”.
E. Criticise the nurse loudly in front of the team so that others “learn not to make stupid mistakes”.

Options:
A. Full candour, safety assessment, escalation and support.
B. Downplays incident and discourages escalation.
C. Partial but still open response, focused on documentation and learning.
D. Minimising the significance and avoiding full candour.
E. Blaming and shaming behaviour.