Resolving Patient Complaints

For most physicians, the resolution of patient complaints ranks second only to firing an employee on the least favorite tasks list. With so many potential problems and the many ways patients can react to them, it seems impossible to construct a template for consistent, mutually satisfactory resolutions.

But it can be done, and it is not as complex as it appears once you realize that the vast majority of complaints have the same basic roots: The patient's expectations have not been met. Sometimes it is your fault, sometimes it is the patient's fault, and often a bit of both, but either way, the result is the same. You have an unhappy patient, and you must deal with it.

I have distilled this unpleasant duty down to a simple three-part strategy:

▸ Discover which expectations went unmet and why.

▸ Agree on a solution.

▸ Learn from the experience to prevent similar future complaints.

In most cases, this is not a job you should delegate. Unless the complaint is trivial or purely administrative, you should address it yourself. It is what you would want if you were the complainant, and it is often too important to trust to a subordinate.

At this point, you may be asking, “Why should I care?” Is the personal expenditure of your time and effort necessary to resolve complaints really worth it? Absolutely, because the old cliché is true: A satisfied patient will refer 5 new ones, while a patient who is dissatisfied will frighten away 20 or more potential patients.

Besides, if the complaint is significant and you do not resolve it, the patient is likely to find someone who will; and chances are you will not like their choice or the eventual resolution.

The easiest way to deal with complaints is to prevent as many as possible. Try to nip unrealistic expectations in the bud. Take the time beforehand to explain all treatments and procedures, and their most likely outcomes, in a clear and honest manner. And, since even the most astute patients will not absorb everything you tell them, make liberal use of written handouts and other visual aids.

And, of course, document everything you have explained. Documentation (I say, yet again) is like garlic: There is no such thing as too much.

But despite your best efforts, there will always be complaints, and handling them is a skill set worth honing. The most important skill is the one most people—especially physicians—do poorly: listening to the complaint. Before you can resolve a problem you have to know what it is, and this is precisely the wrong time to make assumptions or jump to conclusions.

Listen to the patient's entire complaint without interrupting, defending, or justifying. Angry patients do not care why the problem occurred, and they are not interested in your side of the story. This is not about you, so listen and understand.

As you listen, the unmet expectations will become clear. When the patient is finished, I like to summarize the complaint in that context: “So if I understand correctly, you expected “X” to happen, but “Y” happened instead.” If I'm wrong, I modify my summary until the patient agrees that I understand the problem.

Once you know the problem, you can talk about a solution. The patient usually has one in mind—additional treatment, a referral elsewhere, a fee adjustment, or sometimes simply an apology. By all means, let the patient propose a solution.

If the solution is reasonable, I will agree to it; if it's unreasonable, I will try to offer a reasonable alternative. The temptation here is to think more about protecting yourself than making the patient happy, but that often leads to bigger problems. Do not be defensive; remember, this is not about you.

I am often asked if refunding a fee is a reasonable solution. Some patients (and lawyers) interpret a refund as a tacit admission of guilt, so I try to avoid this approach. However, canceling a small fee for an angry patient can be prudent, and in my opinion looks exactly like what it is: an honest effort to rectify the situation. But usually, free (or reduced-fee) additional materials or services are a better alternative than refunding money.

Once you have arrived at a mutually satisfactory solution, document everything. However, consider reserving a “private” chart area for such documentation so that it will not go out to referrers and other third parties with copies of your clinical notes. Consider having the patient sign off on the documentation, acknowledging that the complaint has been resolved.

Finally, always try to learn something from the experience. Ask yourself how you might prevent a repetition of the complaint, what you did that you can avoid doing next time, and how you might prevent unrealistic expectations in the future.

Above all, do not take complaints personally—even when they are personal. No matter how hard you try, you can never please everyone.

To respond to this column, e-mail Dr. Eastern at [email protected]

For most physicians, the resolution of patient complaints ranks second only to firing an employee on the least favorite tasks list. With so many potential problems and the many ways patients can react to them, it seems impossible to construct a template for consistent, mutually satisfactory resolutions.

But it can be done, and it is not as complex as it appears once you realize that the vast majority of complaints have the same basic roots: The patient's expectations have not been met. Sometimes it is your fault, sometimes it is the patient's fault, and often a bit of both, but either way, the result is the same. You have an unhappy patient, and you must deal with it.

I have distilled this unpleasant duty down to a simple three-part strategy:

▸ Discover which expectations went unmet and why.

▸ Agree on a solution.

▸ Learn from the experience to prevent similar future complaints.

In most cases, this is not a job you should delegate. Unless the complaint is trivial or purely administrative, you should address it yourself. It is what you would want if you were the complainant, and it is often too important to trust to a subordinate.

At this point, you may be asking, “Why should I care?” Is the personal expenditure of your time and effort necessary to resolve complaints really worth it? Absolutely, because the old cliché is true: A satisfied patient will refer 5 new ones, while a patient who is dissatisfied will frighten away 20 or more potential patients.

Besides, if the complaint is significant and you do not resolve it, the patient is likely to find someone who will; and chances are you will not like their choice or the eventual resolution.

The easiest way to deal with complaints is to prevent as many as possible. Try to nip unrealistic expectations in the bud. Take the time beforehand to explain all treatments and procedures, and their most likely outcomes, in a clear and honest manner. And, since even the most astute patients will not absorb everything you tell them, make liberal use of written handouts and other visual aids.

And, of course, document everything you have explained. Documentation (I say, yet again) is like garlic: There is no such thing as too much.

But despite your best efforts, there will always be complaints, and handling them is a skill set worth honing. The most important skill is the one most people—especially physicians—do poorly: listening to the complaint. Before you can resolve a problem you have to know what it is, and this is precisely the wrong time to make assumptions or jump to conclusions.

Listen to the patient's entire complaint without interrupting, defending, or justifying. Angry patients do not care why the problem occurred, and they are not interested in your side of the story. This is not about you, so listen and understand.

As you listen, the unmet expectations will become clear. When the patient is finished, I like to summarize the complaint in that context: “So if I understand correctly, you expected “X” to happen, but “Y” happened instead.” If I'm wrong, I modify my summary until the patient agrees that I understand the problem.

Once you know the problem, you can talk about a solution. The patient usually has one in mind—additional treatment, a referral elsewhere, a fee adjustment, or sometimes simply an apology. By all means, let the patient propose a solution.

If the solution is reasonable, I will agree to it; if it's unreasonable, I will try to offer a reasonable alternative. The temptation here is to think more about protecting yourself than making the patient happy, but that often leads to bigger problems. Do not be defensive; remember, this is not about you.

I am often asked if refunding a fee is a reasonable solution. Some patients (and lawyers) interpret a refund as a tacit admission of guilt, so I try to avoid this approach. However, canceling a small fee for an angry patient can be prudent, and in my opinion looks exactly like what it is: an honest effort to rectify the situation. But usually, free (or reduced-fee) additional materials or services are a better alternative than refunding money.

Once you have arrived at a mutually satisfactory solution, document everything. However, consider reserving a “private” chart area for such documentation so that it will not go out to referrers and other third parties with copies of your clinical notes. Consider having the patient sign off on the documentation, acknowledging that the complaint has been resolved.

Finally, always try to learn something from the experience. Ask yourself how you might prevent a repetition of the complaint, what you did that you can avoid doing next time, and how you might prevent unrealistic expectations in the future.

Above all, do not take complaints personally—even when they are personal. No matter how hard you try, you can never please everyone.

To respond to this column, e-mail Dr. Eastern at [email protected]

For most physicians, the resolution of patient complaints ranks second only to firing an employee on the least favorite tasks list. With so many potential problems and the many ways patients can react to them, it seems impossible to construct a template for consistent, mutually satisfactory resolutions.

But it can be done, and it is not as complex as it appears once you realize that the vast majority of complaints have the same basic roots: The patient's expectations have not been met. Sometimes it is your fault, sometimes it is the patient's fault, and often a bit of both, but either way, the result is the same. You have an unhappy patient, and you must deal with it.

I have distilled this unpleasant duty down to a simple three-part strategy:

▸ Discover which expectations went unmet and why.

▸ Agree on a solution.

▸ Learn from the experience to prevent similar future complaints.

In most cases, this is not a job you should delegate. Unless the complaint is trivial or purely administrative, you should address it yourself. It is what you would want if you were the complainant, and it is often too important to trust to a subordinate.

At this point, you may be asking, “Why should I care?” Is the personal expenditure of your time and effort necessary to resolve complaints really worth it? Absolutely, because the old cliché is true: A satisfied patient will refer 5 new ones, while a patient who is dissatisfied will frighten away 20 or more potential patients.

Besides, if the complaint is significant and you do not resolve it, the patient is likely to find someone who will; and chances are you will not like their choice or the eventual resolution.

The easiest way to deal with complaints is to prevent as many as possible. Try to nip unrealistic expectations in the bud. Take the time beforehand to explain all treatments and procedures, and their most likely outcomes, in a clear and honest manner. And, since even the most astute patients will not absorb everything you tell them, make liberal use of written handouts and other visual aids.

And, of course, document everything you have explained. Documentation (I say, yet again) is like garlic: There is no such thing as too much.

But despite your best efforts, there will always be complaints, and handling them is a skill set worth honing. The most important skill is the one most people—especially physicians—do poorly: listening to the complaint. Before you can resolve a problem you have to know what it is, and this is precisely the wrong time to make assumptions or jump to conclusions.

Listen to the patient's entire complaint without interrupting, defending, or justifying. Angry patients do not care why the problem occurred, and they are not interested in your side of the story. This is not about you, so listen and understand.

As you listen, the unmet expectations will become clear. When the patient is finished, I like to summarize the complaint in that context: “So if I understand correctly, you expected “X” to happen, but “Y” happened instead.” If I'm wrong, I modify my summary until the patient agrees that I understand the problem.

Once you know the problem, you can talk about a solution. The patient usually has one in mind—additional treatment, a referral elsewhere, a fee adjustment, or sometimes simply an apology. By all means, let the patient propose a solution.

If the solution is reasonable, I will agree to it; if it's unreasonable, I will try to offer a reasonable alternative. The temptation here is to think more about protecting yourself than making the patient happy, but that often leads to bigger problems. Do not be defensive; remember, this is not about you.

I am often asked if refunding a fee is a reasonable solution. Some patients (and lawyers) interpret a refund as a tacit admission of guilt, so I try to avoid this approach. However, canceling a small fee for an angry patient can be prudent, and in my opinion looks exactly like what it is: an honest effort to rectify the situation. But usually, free (or reduced-fee) additional materials or services are a better alternative than refunding money.

Once you have arrived at a mutually satisfactory solution, document everything. However, consider reserving a “private” chart area for such documentation so that it will not go out to referrers and other third parties with copies of your clinical notes. Consider having the patient sign off on the documentation, acknowledging that the complaint has been resolved.

Finally, always try to learn something from the experience. Ask yourself how you might prevent a repetition of the complaint, what you did that you can avoid doing next time, and how you might prevent unrealistic expectations in the future.

Above all, do not take complaints personally—even when they are personal. No matter how hard you try, you can never please everyone.

To respond to this column, e-mail Dr. Eastern at [email protected]