How to Prevent a Complaint From Becoming a Lawsuit

Kathryn Moghadas, RN, CHBC, CLRM

Disclosures

March 09, 2012

Introduction

It's one thing for a patient to have a complaint about you or your office; it's another thing for that complaint to become a lawsuit. Physicians can make sure they nip that in the bud before a complaint escalates.

Doctors should implement a written grievance process that provides an opportunity for a patient (or the patient’s representative) to air the problem and a way for the doctor to remedy the grievance. This can prevent a grievance from becoming a malpractice claim. (Medical practices under accreditation criteria from AAAHC, JCHAO, or Medicare COP, etc., have separate policy standards.)

Why do so many grievances and complaints occur? In a perfect patient visit, the patient sees the doctor at the appointed time, and is ushered into an exam room by a knowledgeable and friendly medical assistant. The doctor listens quietly to the patient, asks appropriate questions, performs the physical exam, renders a medical decision, explains the decision, prescribes a treatment while conveying empathy and concern, and asks, "Is there anything else I have not covered or you have not told me?"

However, life is not perfect. While a medical practice staff is usually efficient and compassionate, the process sometimes gets hijacked. A patient walks away with a negative reaction that will either diminish or become inflamed. Patient complains and grievances occur even when you conduct a near-perfect visit.

The patient leaves without a remedy for their concerns and may tell others about their poor treatment, complain to their insurance carrier, or, in extreme cases, file a malpractice claim.

The medical practice that adopts a clear policy for handling grievances provides a remedy that prevents the escalation of a negative outcome. The grievance process does not have to be lengthy, nor does it need to involve costly litigation.

Don't Keep the Policy a Secret

If only you and your staff know the grievance policy exists, it won't accomplish its goals. It's important for you to post notifications or even have a "suggestion box" and make forms readily available. Or you may give a copy of the grievance policy to all patients signing in after its implementation.

Make sure the complaining patient knows that you -- the physician -- will see the complaint and that you are going to do something about it. Even if the complaint involves only the billing department or the waiting room, all patients know (or believe) that unless a doctor sees the complaint, no improvement or reparation will follow.

It's important to post signage telling patients how to contact appropriate individuals (usually the practice administrator, quality or compliance officer, or risk manager) if they have questions or concerns. This helps prevent patient concerns from escalating into larger problems.

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