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Listen and learn

Amanda Bryan
Med J Aust
Published online: 16 July 2012

Three steps to avoiding a lawsuit

Patient complaints come with the territory in a medical practice, but most grievances will stay within the practice if they are promptly acknowledged and addressed.

A complaint can pack an emotional punch, so the biggest challenge is keeping a clear head to mount a professional response and avoid a potential lawsuit.

This is where a formal complaints-management policy can help, according to medical defence organisations.

This policy should outline the steps to take if a patient complains. It should cover who deals with the complaint, how it’s handled, at what point staff should involve a doctor or practice manager, and when to call your medical defence organisation.

Last year Keryn Hendrick, risk education manager for medical defence organisation MIGA, conducted workshops for doctors entitled The complaining patient.

“What was interesting is many doctors in attendance said they either didn’t have a complaints-handling policy or if they did, they weren’t particularly aware of it”, Ms Hendrick says.

She says a clear written complaints policy provides staff with direction and support in managing potentially difficult situations.

Depending on the size of the practice, this policy can be in writing or more informal, says Dr Sara Bird, the manager of medicolegal and advisory services at MDA National. The most important thing, she says, is that everyone in the practice is on the same page.

A successful complaints-management policy should include the following key elements:

1. Listen

It’s natural for people to respond with anger, frustration or distress in the face of a complaint, but listening is a far more effective strategy.

Hear the patient out, get a good handle on their version of events, and attempt to stand in their shoes, Dr Bird advises.

“Sometimes the patient is correct and sometimes not”, she says. “More often a complaint is the result of the different perceptions of the patient and the doctor: there hasn’t been a shared understanding of exactly what’s happened.”

2. Acknowledge

Ms Hendrick says that once the patient has voiced their concern, it helps to show empathy and acknowledge that something upsetting has occurred.

“If they don’t get that, that’s when they may look to a complaints entity to step in and resolve [the situation] for them”, she says.

Dr Bird says it’s worth designating a skilled staff member to handle complaints, but because you can’t always press a pause button, your front-line staff still need skills in managing distressed or angry patients.

“In surveys of patients that ask about what they want when making a complaint, they said they wanted acknowledgement”, she says. “Allow them to tell their story and really try to understand where they are coming from.”

Sometimes issues can be resolved on the spot. Dr Bird says an apology for distress or a misunderstanding, for instance, may be appropriate and sufficient.

“Patients may have unrealistic expectations of what the practice can provide, and sometimes they are anxious and unwell and therefore more easily aggrieved”, she says. “There are many matters where the doctor involved would just phone the patient and resolve the problem then and there — and that’s the ideal way.”

A study published in the Medical Journal of Australia in 2004, which examined complaints made by patients attending Victorian hospitals, found that 84.5% were resolved easily and more than half were resolved with an apology or explanation. (https://www.mja.com.au/journal/2004/181/1/analysis-complaints-lodged-patients-attending-victorian-hospitals-1997-2001)

However, Dr Bird says if a patient puts their complaint in writing, you should seek advice from your medical defence organisation.

3. Promise to take action

Most patients who complain are not seeking financial compensation — they tend to have altruistic motives.

“Patients often don’t want others facing similar problems and they are looking for a sense that the service has improved for them and others in future”, Ms Hendrick says.

“If things need to change in your systems and procedures, tell them about those changes.”

She says your initial conversation should include an assurance to the patient that their concerns will be investigated and addressed. It’s also important to provide the patient with an explanation, she says.

Medical defence organisation Avant agrees. Ms Georgie Haysom, special counsel in medicolegal advisory service/health law at Avant, says timely and skilful handling of complaints can help to reduce the risk of a formal complaint or a claim being made.

“Leaving a patient complaint unanswered can exacerbate the patient’s dissatisfaction, so we recommend responding quickly, with an emphasis on resolving concerns”, she says.

Dr Bird says the patient also needs to know at the outset that you will respond to their grievance within a set time frame — say within 2 days or 2 weeks, depending on the nature of the complaint.

She suggests you also thank the patient for bringing their concerns to your attention.

Why do patients complain?

According to MDA National, one in 20 medical practitioners will be the subject of a formal complaint to the Medical Board of Australia or the Australian Health Practitioner Regulation Agency each year. Dr Bird says doctors tend to attract the most complaints in two key areas:

1. Not fulfilling expectations

This includes allegations about delays in diagnosis and treatment, complications of treatment and inadequate or inappropriate treatment, including failure to examine properly or order investigations, or prescription of incorrect medications.

2. Failing to communicate

This includes allegations of inadequate, incorrect or misleading advice, and complaints about the doctor’s manner, such as allegations of rudeness or an uncaring attitude.

Risk management tips

Medical defence organisation MIGA offers the following approach to resolving complaints:

  • Where possible, deal directly with the complainant
  • Try to resolve complaints as quickly as possible
  • Have a complaint-handling procedure led by a senior staff member
  • Ensure all staff – doctors, nurses and practice staff – are aware of the procedure, and that locums receive instruction as part of their induction
  • Display your complaints procedure in the waiting room.
  • Amanda Bryan


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