Patient Complaints: How to Stop Them Before They Start

Published on: February 6, 2012

Studies show that the leading reasons for patient complaints include: delayed receipt of test results; excessive wait when scheduling an appointment or waiting to see the doctor; staff rudeness or a doctor’s poor “bedside manner;” and billing errors. Anticipating problems and responding promptly to com-plaints can prevent an unhappy patient from threatening to sue or hiring an attorney.

How to avoid patient complaints:

The best way to avoid patient complaints is to establish a positive physician-patient relationship and nurture the health of the relationship over time.

• Make a good first impression. Telephone triage, scheduling, and front office staff should communicate a message of “welcome” to your practice. A positive first encounter (whether in person or over the phone) will set the tone of the relationship.
• Treat patients with respect. Ensure that your staff answers the phone promptly and courteously. Actively listen to patients’ concerns and respond appropriately. Protect their privacy and the confidentiality of their healthcare information. If long waits in the reception room are common, re-evaluate scheduling policies. Apologize for delays.
• Communicate effectively. Studies have shown that patient satisfaction and clinical outcome are positively impacted by verbal communication that is empathetic, reassuring, patient-centered, includes some laughter or joking, positive reinforcement, and more. Nonverbal communication, such as appropriate eye contact, head nodding, and forward-leaning posture, is likewise associated with patient satisfaction and positive clinical outcome.
• Educate patients about their medical conditions. Obtain and document informed consent or refusal. Report diagnostic test results to patients in a timely manner. Note: Only a physician should inform patients of significant or abnormal test results, and explain if follow-up is needed. The doctor can delegate to staff members the responsibility of informing patients about normal test results. Advise patients about office policies (e.g., limitations on medication refills after hours, fees charged for missed or late appointments, etc.) State these policies in an attractive, inexpensive patient information brochure that is given to new patients and also displayed in the reception area. (Sample patient information brochures are available on MIEC’s website at www.miec.com in the publications section under the Managing Your Risk tab.)

What should you do when patients complain?

• Seriously consider the complaint no matter how trivial it may appear. Much may be learned from unsolicited complaints (see What can you learn from patient complaints?).
• Develop clear policies about responding to complaints. Staff should be advised to whom various complaints are to be addressed. Only physicians and other licensed providers should respond to complaints about medical care. The office manager or practice administrator should address complaints about staff and other non-clinical complaints while the medical director should respond to concerns about group physicians or midlevel providers. All billing staff should be properly trained to respond to patients’ questions about their outstanding balances.
• Train staff members to handle patient complaints professionally, courteously, and respectfully. Communication courses from various professional sources are available for staff. MIEC’s Loss Prevention team also is available to provide some effective communication training. Education should include advice to: calmly and professionally discuss the complaint; do not allow a patient’s anger to trigger your own; be patient and considerate; and, end the discussion if the patient becomes abusive.
• Track complaints. What types of patterns appear? Do they denote systems failures? Are there communication issues with staff or physicians? Provide feedback to staff or clinicians individually (when appropriate) or during a staff/office meeting.

When responding to complaints about a patient’s medical care and treatment:

• Get advice from MIEC’s Claims Department before responding to significant complaints about medical care. In some instances, the Claims representative may obtain legal advice on your behalf, or retain legal counsel to assist. For general questions about responding to complaints, contact MIEC’s Loss Prevention Department.
• In complex situations, invite the patient or family members to an office conference, or ask for a letter that states their concerns. Get advice from an MIEC Claims representative on how to handle the discussion or co-plaint letter response. Listen to the complaint and ask what the patient thinks is an appropriate solution to the problem.
• Establish a policy for reducing or waiving fees in response to a complaint. Waiving a fee may be seen as admitting liability. It may be prudent for the doctor to first discuss the reasons for a fee waiver with an MIEC Claims representative. Staff members should not adjust fees without physician approval.
• Reduce fee complaints by introducing new patients to the billing manager, who can explain billing policies and your obligation to collect insurance co-payments. In your patient information brochure explain your policies and procedures (P&P) and the patients’ responsibilities as they relate to the P&P.
• Defense attorneys advise physicians not to admit liability or negligence when discussing a complaint. It is appropri-ate to express empathy or apologize for the patient’s concern, but not to accept or infer blame. Bad outcomes or adverse incidents are not necessarily measures of the quality of care. Do not promise the patient or the patient’s family compensation, including a fee reduction, for an injury or adverse reaction to treatment or medication before consulting with an MIEC Claims representative. MIEC is not obligated to honor reimbursements negotiated without prior approval. For more information, review “How to say I’m sorry? Let me count the ways,” Special Report MIEC Claims Alert, Number 38.
• Do not discuss medical complaints or respond to letters from patients’ attorneys -without advice from an MIEC Claims representative. Conversations and correspon–dence with patients’ attorneys are not privileged. That is, any-thing you say or write can be used against you in litigation.
• n Document all medical complaints and details of discussions with the patient or an authorized family member, even if the problem appears to have been resolved. The documentation establishes a date on which the patient was aware of an alleged injury that could later be a cause of action for a lawsuit. The statute of limitations for filing a mal-prac-tice suit begins to run either from the date of injury or the date of discovery. The date a patient first com-plains may determine the dis-covery date used in litigation.

What can you learn from patient complaints?

Gerald B. Hickson, MD, and his colleague James W. Pichert, PhD, from the Center for Patient and Professional Advocacy (CPPA) at Vanderbilt University in Nashville, Tennessee, have learned much from unsolicited patient complaints. In their contribution to the AHRQ 2008 compendium Advances in Patient Safety: New Directions and Alternative Approaches, Drs. Hickson and Pichert reasoned that patients can promote safety and help reduce risk,

“One [way] is to make known their concerns about their health care experiences because complaints might suggest unsafe systems and providers . . . Good teams make for optimal outcomes and patients are integral members of the health care team. When patients are forgotten or not integrated into ongoing decision making, outcomes suffer. Therefore, we believe patient complaints are often markers of dysfunctional teams, and addressing those physicians who are associated with the greatest expressions of patient dissatisfaction might create better teamwork and greater safety.” (“Using Patient Complaints to Promote Patient Safety,” pages 1-2)

Since the 1990s, Drs. Hickson and Pichert, together with the CPPA team, have researched why patients sue their doctors and why certain physicians attract more lawsuits. Their research led them to develop the Patient Advocacy Reporting System (PARS®), a process for identifying and intervening with high-risk providers. Among their most significant conclusions: there is a link between malpractice suits and frequent patient complaints about providers who display disruptive behavior. For more information about this vital patient safety research and resource, visit Vanderbilt Center for Patient and Professional Advocacy.