1. Dr Nick Flynn IMC 21468
Dealing with complaints from those with Mental Illness, Addiction, Intellectual Disability and other care settings.
Thursday 11/05/2017
Royal Marine Hotel
Dun Laoghaire

3. Steve Jobs picked Hollyhill himself!
Apple Computers employ 3000+

4. Objectives of todays session
Nuances when dealing with complaints from patients with Mental Illness and Drug Addiction
How to help patients we are concerned about
Case Study.
Discuss the fallout of unreasonable complaints in clinical practice

5. Mental Illness is common:

6. Mental Illness in Ireland 2009: In a one-year period due to MI1
320,381 patients attend their GP
160,190 attendances OPD clinics
51,261 attendances at day centres
19,222 pts admitted
Reference: 1Health Research Board 2009
19,222 admissions

7. Mental Illness in Ireland
2/5 people experience mental illness in their lifetimes 1
To 1/17 people it will be serious and disabling1
Reference: 1Health Research Board 2009

8. Drug Addiction in Ireland
Alcohol
Cannabis
Opiates (Heroin)
Cocaine
54% of year old drinkers were classified as harmful drinkers which equates to 1.35 million harmful drinkers in Ireland
6.0% of the adult population (aged 15–64), and 12.9% of those aged 15–24 years, had used cannabis in the year1
0.4% of adults (aged 15–64) reported Opioid addiction in 2012
2.8% of young adults
(aged 15–34) reported cocaine use in the previous year

9. Models of consultation
Teach consultation skills
Improve consultation skills
Guide the consultation
Analyse good and bad consultation
Help us when analysing mistakes
Help us when analysing complaints

10. 1997 Stewart and Roter Consultation Model
Patient’s Agenda
Doctor’s Agenda
Merging of both frameworks to give a shared understanding

11. 1997 Stewart and Roter Consultation Model
Hairdresser / barber
Repeat script for oral contraception
Headache:
Sick cert V brain tumour

12. Why do patients complain?
Access
Communication
Treatment

13. Depression Body Appetite Sleep Energy Mood Sadness Lack of interest
Thoughts
Body
Appetite
Sleep
Energy
Mood
Sadness
Lack of interest
Thoughts
Guilt & low self worth
Negative thoughts

14. Anxiety Appropriate reaction in certain situations
Physical symptoms
Worried and nervous
Powerless
Impending doom
Appropriate reaction in certain situations
Pathological Anxiety

15. Psychosis Delusion = fixed and false belief not responsive to evidence
Patient can be “out of touch with reality”
Delusion and hallucinations are hallmarks
Insight often lacking
Delusion = fixed and false belief not responsive to evidence
Hallucination = false sensory experience

16. Stewart and Roter Model Drug Addiction
Intoxicated or in withdrawal
Antisocial behaviour
Medication issues
It’s “my” medication
I “lost” my medication
Pushing the boundaries “one more week”

17. Complaints from patients with Mental Illness and Drug Addiction
Patients who have a complaint
Patients who make a complaint

18. Considerations when protecting the patient
Follow your complaints protocol:
The patient is at the centre of everything we do
Offer to meet and discuss with the patient
Don’t act alone, discuss with a colleague
Carefully document your decision making process
Discuss with your insurer

19. Case Study Day One Day Two Month One
Hollyhill Medical Centre is based in a deprived urban setting
In 2012 we took over the care of 800 GMS patients at short notice
c.350 of these patients had extraordinary forensic, drug addiction and mental health needs
Day One
Day Two
Month One

20. Challenges Change imposed on the patients No choice of doctor1
Change imposed on the patients 2
No choice of doctor 3
Inappropriate health seeking behaviours / health beliefs 4
High dose Benzodiazepines 5
High dose Codeine medications 6
No medical records received!

21. Strengths Cooperation with local GP practices Support from HSE1
Cooperation with local GP practices 2
Computerised practice & Existing practice infrastructure 3
Experienced administrative staff 4
Experienced clinical staff 5
Support from HSE

22. Methods Correct patient Correct prescription All GPs in Cork on alert
Fair
Consistent

23. Process Meetings with HSE (5) Practice meetings Agreed protocols
Signs in the waiting room
Immediate large reduction in scripts
Then slowly reduced over 12 – 18 months
Patient contracts – sanctions explained.

24. Results Codeine scripts in line with national averages
Benzodiazepine scripts reduced >70%
Patients report – improved quality of life
Crime in Hollyhill decreased
Three patients RIP from complications of drug related activities (3 X OD).
All heroin overdoses.
Methadone clinic established

25. Consequences of unreasonable patient complaints
Defensive medicine
Spiralling insurance
costs
Overuse of investigations/tests
€10,000 MPS IRE
Over referral to secondary care
€35,000 OOH UK
Inappropriate use of scarce resources

26. Summary Mental Illness and Drug Addiction are common and maybe subtle.
A complaint from a patient with a Mental Illness or Drug Addiction may be part of their condition.
Patients with Mental Illness and Drug Addiction who complain still need to use our services – don’t break the relationship.
General Practice is an efficient, dynamic and functioning part of the Health Service.

27. Thank you
Questions?
@drnickgp