How to Effectively Issue a Medical Complaint

By Dr. Nathan, MD

If you feel you are not receiving the medical treatment you need and deserve, speak up!

Often the matter can be resolved with just a conversation. If you feel a complaint is appropriate, here

are a few suggestions to help you present a polite, direct, and successful critique of your medical provider.

Doctors, nurses and other professionals work in health care because they enjoy helping others. Con-

sequently, they generally place a high priority on assisting patients to have positive experiences.

However, some patients have very negative experiences despite all efforts. Often the problem is a

minor one and not worth the sustained attention required to complain.

Communication

First, discuss the problem directly with your doctor or nurse. On many occasions the professionals

most closely involved in you or your child's care will be unaware of your dissatisfaction. A direct

discussion is the fastest, most effective way to resolve issues. If you are afraid that voicing a com-

plaint, will cause caregivers to be angry at them and provide poor treatment as a result; Keep in

mind this is rarely true, but that feeling of vulnerability is understandable. If you do not feel com-

fortable talking directly with your doctor or nurse, most hospitals and large clinics have patient rep-

resentatives who will listen to your concern and help you get it resolved. If direct discussion has not

resolved your concern, you should consider a written complaint.

When to Write a Formal Complaint

Written complaints take valuable time and effort for you and for the professionals who must re-

spond to them. You should be sure that your complaint is worth this effort. If the answer to any of

these questions is yes, you should probably write a formal complaint. Does your problem affect fu-

ture care? Is your concern one that other patients are likely to have in the future? Will this issue af-

fect future decisions of where and from whom you will receive future care?

Writing an Effective Complaint

Having read numerous complaints (as a representative of an organization, not about me personally),

I am amazed at the variation in complaint letters. Some are compelling appeals for assistance and

others are mindless tirades that reflect generalized anger at life. If you have a legitimate concern,

write a letter that is most likely to result in favorable resolution of your concern. The effective com-

plaint letter is written to the Chief Executive Officer of the hospital or health plan and has four ele-

ments:

1) a compliment,

2) detailed description of the event,

3) expression of disappointment, and

4) a proposed resolution.

Start out complimenting

Start out complimenting the organization or persons about whom you are complaining. You chose

them for your care because you thought or had heard that their care would be good. Repeat this pre-

vious assumption. This helps to establish the fact that you are not mad at the world and began with

an open mind. This also indicates that if this problem can be resolved, you will continue to have a

high opinion of their service.

Describe in detail the situation that occurred

The more detail you can provide, the more seriously your complaint will be taken. Detail also helps

hospital personnel reconstruct the chain of events that resulted in your negative experience. Try to

stick with the facts without ascribing motives to people's actions.

Express disappointment

What happened did not meet your expectations. Explain the gap between what you thought would

happen and what actually occurred. Any anger, frustration, sadness or disappointment you felt

should be explained here.

Offer a resolution

Often the thing that will make you feel the best is just to have someone say that they are sorry you

did not have a good experience. If that is the case, ask for an apology. If you feel that specific ac-

tions need to be taken, list them. For example, if you feel your privacy was not respected, state that

and ask for an apology and promise to provide better privacy in the future. If you felt you did not

receive an adequate explanation of your care, ask for an apology and a promise of more detailed

information in the future. Generally, those responding to your complaint will appreciate a reason-

able suggestion through which the situation can be resolved.

If your letter goes unanswered, you can either call or write another letter. My preference is

to telephone. Depending on the response to your call, you may choose one of several op-

tions. Send a letter to the Chairman of the Board of Directors indicating that you have sent a

previous, unanswered letter. This almost always elicits a prompt response.

If you have done the above and still cannot get resolution, you can write to the state agen-

cies that license doctors, nurses, hospitals, and health plans. Often different agencies over-

see each of these caregiver groups. They will almost always require a written complaint.

If all of the above has not resolved your concern, and you feel that you have been signifi-

cantly harmed by what happened, you should consider a consultation with a lawyer.

Identifying differences in hospital quality is difficult for patients. There are several sources

of information that you can use to know more about your hospital. Knowing someone who

works in the medical area remains the best way to know which hospital provides the best

service in your area.

Dr. Nathan is a neonatal pediatrician with over 25 years of experience in caring for sick infants

and children and has been selected as one of the top pediatric specialists in the Twin Cities area