Responding to a direct patient complaint

• Your patients like to feel heard, so make it easy for them to raise concerns. When your patient does raise a concern, take it seriously and respond promptly.
• When something goes wrong with your patient, it’s important to take ownership and say sorry.
• Think about patient feedback as an opportunity to improve.
• If you’re concerned about a patient complaint, contact Avant.

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 initially handles feedback, concerns or complaints can deescalate it or even resolve it at an early stage. It’s better for all involved if patients feel comfortable raising concerns directly with you or your practice, rather than going to the regulator or complaints body.

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

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

Many patients complain because they feel unheard and unacknowledged. That means miscommunication or a lack of knowledge is a key cause. It’s natural for a patient to complain if something goes wrong, but more specifically, it is more likely that they will complain if the outcome does not match their expectations.

Patients are less likely to complain about a sub-optimal outcome if they already have a good therapeutic relationship with you or if they were warned of the possible outcomes. This highlights the importance of a sound consent process that shares decision making about clinical management with the patient.

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.

Patient complaints may be made by the patient themselves, a family member or someone else close to them who is concerned about their care.

First response is critical

It is important to respond promptly after hearing about a patient’s concerns – do not ignore feedback or 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 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.

Your initial response to a direct complaint from a patient is crucial as it will influence whether the patient escalates their concerns further – to their lawyer, the Australian Health Practitioner Regulation Agency (Ahpra), a state-based complaints entity or a privacy commissioner. It is important that all practice staff understand the significance of their response if they are the first point of contact.  

If patients perceive 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.

Listen and understand

Take all patient concerns seriously and consider whether you need specific advice from Avant about your 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 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.

Unexpected or adverse outcomes

If the patient has had an unexpected or adverse outcome, acknowledge the patient’s distress, take ownership and say sorry. 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”.

If the complaint arises from an adverse clinical incident that caused harm to the patient, follow a formal open disclosure process. This process should be followed as soon as you become aware of an adverse event – do not wait for a complaint to be made. See Avant’s factsheet Open disclosure: responding when things go wrong.  

Follow up in writing

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

• acknowledgment of the patient’s point of view
• a description of the factual information addressing the issues raised
• clarification or correction of misunderstandings 
• an apology
• a description of changes 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 suggested action that may resolve the patient’s complaint, if appropriate.

Ending the doctor–patient relationship

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. For guidance about managing this, see our factsheet: How to end the doctor–patient relationship.

Have a practice policy

You should have a practice policy for dealing with feedback and complaints from patients. This will help you manage complaints in a systematic way. Your staff should be trained about the policy, so they are aware of their responsibilities. Remember to inform all your patients about your policy and how they can provide feedback.

The policy should outline who is responsible for dealing with feedback or concerns. We recommend having a designated staff member as the point of contact for 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.

Outstanding payments

If payment is outstanding at the time of the complaint, you may 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.

Quality improvement

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

De-identify patient complaints and discuss them at your practice meetings. This will help ensure a collaborative approach to managing complaints, demonstrate that complaints are taken seriously and prompt discussions about improvements in the practice. Include the discussion in the meeting minutes. For every complaint, ask:

• Is staff training required?
• Is patient education required?
• Can our systems improve to reduce confusion or misunderstanding?  
• How can we prevent a recurrence?
• What can we do to improve?

One study found that 95% of doctors experienced stress during the complaints process¹. This stress is at its worst when you initially receive the complaint. It can interfere with your professional and personal life.

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 Services

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