Responding to a direct patient complaint

• Act on every complaint you receive and have a system in place to respond promptly and clearly.  
• Create a practice culture of valuing complaints instead of feeling threatened by them.  
• Acknowledge a patient’s concerns and respond with understanding - this can help deescalate the complaint. 
• Consider any options for improvement to your practice and let the patient know of the steps you’ve taken.  

Receiving a complaint can be confronting. Complaints often occur because a patient’s expectations were not met in some way. How a doctor or practice handles a complaint initially can assist in deescalating the complaint and even resolving it at this early stage, which is a better outcome for all involved.  

It is also ideal for all involved if patients feel comfortable raising concerns directly with you or your practice, rather than going directly to the regulator or complaints body. 

All patient feedback, including complaints, can be used to identify problems and improve the quality of the healthcare that you and your practice provide. Responding to complaints demonstrates that you value your patient’s opinions and needs, and this can contribute to a more positive healthcare experience for the patient.  

You should notify Avant of any matter you become aware of that could lead to a claim or complaint. We can also assist you in determining the best approach or response to the situation. By itself, a notification has no adverse impact on your claims history.  

Patient complaints can made by the patient themselves, a family member or someone else close to them concerned about their care. The basis of many patient complaints is miscommunication or a lack of knowledge. Patients may complain if something goes wrong, but more specifically if the outcome does not match what they were expectatng. They are less likely to complain about a sub-optimal outcome that they were warned of and knew was a possibility. This highlights the importance of a sound consent process that shares the decision making with the patient about any clinical management or procedure you propose. 

Patients may also complain about non-clinical aspects of their experience. These could include: fees that were charged, the amount of time kept waiting for the consultation or breaches of their privacy. These too can be linked back to their expectations not being met in some way.  

When a patient complains it can be important to them that their grievance is heard, acknowledged and understood. Often they want an explanation in response to their concerns and may also like an apology if something went wrong or was perceived by them as having gone wrong.  Most patients who have had a bad experience, significant enough to complain, would also like to see some improvement or change. This is to reduce the risk of something similar happening to someone else. 

When you receive a complaint directly from a patient, the initial response is crucial and will influence the patient’s decision to potentially escalate their concerns further - to their lawyer, the medical regulator or a complaints entity (for example, the Australian Health Practitioner Regulation Agency (Ahpra), state-based complaints entity or federal or state privacy commissioner). For this reason, it is important that all staff at the practice understand the significance of their response if they are the first point of contact.   

If patients perceive that their complaint is being taken seriously and is being handled by someone with sufficient authority and sensitivity to address and resolve their concerns, they are generally more likely to accept the outcome.  

It is important to act promptly - do not ignore complaints. If a complaint cannot be dealt with immediately, acknowledge that you have received the complaint and let the patient know when they can expect a response. 

One aim of resolving the complaint early is to try to preserve the therapeutic relationship with the patient. This involves listening to the patient’s concerns and showing empathy, even if you think the complaint is trivial or you do not accept the basis of the complaint. 

You should have a policy at your practice for dealing with complaints from patients. This will help you deal with complaints in a systematic way. All protocols in your practice should also be supported by training for your staff, so they are aware of the protocol and their responsibilities. 

Protocols should outline who is responsible for dealing with complaints. We recommend that you designate a staff member as the single point of contact for all complaints about your practice.  

Doctors should deal with complaints about clinical care but complaints about the practice or administrative issues could be dealt with by the practice manager.  

It if often appropriate to deidentify and discuss patient complaints at practice meetings and include the discussion in the minutes of those meetings. This will help ensure a collaborative approach to managing the complaint and will demonstrate that the complaint has been considered and prompted discussions about improvement in the practice.  

Consider whether you need specific advice from Avant about the complaint and/or plan of action before you respond.  

Where possible and appropriate make personal contact with the patient by phone. 

Make sure you fully understand the nature of the complaint and the patient’s main concerns. You may need to take some time to gather the facts but advise the patient if this is the case. 

Where appropriate, suggest a face-to-face meeting to discuss the patient’s concerns. Encourage the patient to bring a relative or friend to accompany them if they wish. Suggest an interpreter if language is a barrier. Allow plenty of time. Find a quiet, private room for the conversation. You should not charge the patient for this discussion.  

Show empathy to the patient even if you do not accept the basis of the complaint. 

If the patient has had an unexpected or adverse outcome, acknowledge the patient’s distress and, if appropriate, validate it. If you are also upset about an outcome, there is nothing wrong with demonstrating empathy or apologising, using a phrase such as “This is not the outcome either of us wanted or anticipated”.  

In some cases, it may be appropriate to follow up the discussion with the patient with a written response. An effective response usually contains the following elements: 

• Acknowledgment of the patient’s point of view.  
• A description of the factual information to address the issues raised. 
• Clarification or correction of misunderstandings.  
• An apology.  
• A description of changes that you will make in your practice to avoid a similar set of circumstances, or at least an assurance that you have considered the patient’s comments carefully.  
• A suggestion for an action that may resolve the patient’s complaint, if appropriate. 

 If the complaint arises from an adverse clinical incident that has caused harm to the patient, follow a formal open disclosure process. This process has the same elements as outlined above but is a structured approach to managing adverse clinical events. This process should be followed as soon as you become aware of an adverse event, and not wait for a complaint to be made.  See further Avant’s factsheet Open disclosure   

Every complaint should be a learning opportunity – use complaints to recognise possible problems with your systems or expectations of your patients.  

With every complaint ask:  

• is there more training of staff required?  
• is there more education for the patients required?
• can our systems improve to decrease confusion?
• how can we prevent a recurrence?  
• what else can we do to improve? 

 Delay billing the patient or pursuing payment until the complaint has been resolved. Pursuing payment when there is a complaint can lead the patient to take the matter further. As an act of good will, consider not sending a bill. 

If the payment is outstanding at the time the complaint is raised, you can consider not pursuing payment until the complaint has been resolved. You may be asked by the patient to waive your fees or refund them. This is not required but can be done as a gesture of goodwill.  

Sometimes, despite your best efforts, the therapeutic relationship will have broken down to such an extent that you feel the relationship can no longer be sustained. There are ways of managing this, see our factsheet: How to end the doctor-patient relationship.

One study found that 95% of doctors experienced some degree of stress during the complaints process. This stress is at its worst when you initially receive the complaint. It can interfere with your professional and personal life.¹ 

It is important to take care of yourself and seek support if you need it. Please see Avant’s Health and Wellbeing resources for more information. 

1. Bismark, M., Spittal, M., Studdert, D., (2013) Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia. BMJ Qual Saf 2013;22:10 879880 doi:10.1136/bmjqs-2013-002340 

Avant factsheet: Responding to negative feedback online 

For sample complaints handling protocols, template letters and other useful resources, see Australian Commission on Safety and Quality in Healthcare’s Complaints Management Handbook for Health Care 

For medico-legal advice, please contact us on nca@avant.org.au or call 1800 128 268, 24/7 in emergencies.