The doctor or the practice – who should respond to a patient complaint?

Sometimes the complaint is like a hot potato, and no one wants to take responsibility for it. At other times, the practice provides a substantive response when it may not be appropriate to do so.

Below we discuss ways to best manage these common dilemmas.

The complaint is solely about the clinical care

If you’re a practice owner or practice manager, you may feel the need to respond and protect the reputation of the practice. But a complaint about a doctor’s clinical care should be addressed by the doctor involved, for a number of reasons including:

• prompting the doctor to contact their MDO for advice
• reflecting on the care provided
• providing a considered response, which may form part of an investigation if the complaint is escalated. This doesn’t mean the practice should ignore the complaint entirely, but we recommend a holding response along the following lines.

Does the advice change if the doctor is a registrar?

No. A registrar should treat a complaint as a learning opportunity, and a chance to engage with their own MDO. The best thing the practice can do is support the registrar through the process.

The practice can send a holding response, but it should avoid offering to ‘investigate’ the complaint or provide details of any findings to the patient. This can be unhelpful to the registrar, particularly if the matter goes further.

If part of the complaint relates to supervision – for example, the registrar checked something with the supervisor and received incorrect advice – it may be appropriate for both the registrar and the supervisor to provide a joint response with input from their individual MDOs.

The complaint is about the practice and clinical care

This may require a joint response, or two separate responses, depending on which allegation is more significant. If the patient complains about everything – from the booking system, wait times, the receptionist – adding a throwaway line about the doctor being disinterested, a single line response from the doctor could be incorporated into the overall practice response.

If, however, there are legitimate concerns raised about both the practice and clinical care, the practice could adapt the holding letter to incorporate a response to any issues raised about the practice. The complaint should then be referred to the doctor for a separate response with the assistance of the doctor’s MDO.

The complaint entirely relates to the practice

If the complaint does not involve clinical care, the practice should contact their practice insurer for advice on how to respond.

What if we don’t want the patient to come back to the practice?

If the patient has been rude or abusive, and the therapeutic relationship is irretrievable, the practice or the doctor can incorporate a termination letter¹ into the response.

Case study

John had been a patient of the practice for years, but he took a dislike to Carli, a female registrar. When he couldn’t see his usual doctor, he reluctantly agreed to see Carli for an urgent appointment.

Despite John being belligerent throughout the consultation, Carli did her best to examine him and provide clinical advice. John was annoyed that he couldn’t see his usual doctor, and he wasn’t happy with Carli’s advice, so he made a complaint to the practice.

Carli’s supervisor and practice owner, Dr James, didn’t want to undermine Carli’s confidence, so he decided to respond to John himself:

Dear John

I’m sorry I wasn’t available to see you for an urgent appointment last week, but I had a commitment that could not be moved.

You indicated you were unhappy with Carli’s treatment plan. She recommended rest and fluids, but otherwise suggested you take a “wait and see” approach with regards to your chesty cough.

I would have commenced antibiotics immediately, but we need to make allowances for young doctors who are still training and have limited practical experience.

Carli will be moving on soon, so I trust I will see you next month for review of your chronic disease management plan.

Kind regards

Dr James completed a very positive assessment and Carli moved on to another practice. She was shocked to receive a complaint from Ahpra a few months later. It included Dr James’ response, which John had used as proof of her “complete and utter negligence”.

The matter was ultimately dismissed. But Carli felt completely blindsided by Dr James’ failure to advise her of the concerns raised, and his unhelpful response which she believed prompted John’s notification to Ahpra.

References

1. MDA National. Ending the doctor–patient relationship

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