As long as there have been doctors, there have been patients who complain about doctors. Long wait times, no magic cures and bedside manners fuel the grumbling.
“Patients have complained about the quality — or the lack thereof — of the healthcare they receive, even before social media,” said Dr. Iris Thiele Isip Tan. “Social media, though, has provided a platform where such complaints can get more mileage.”
Tan is an endocrinologist and clinical associate professor at the University of the Philippines College of Medicine. She blogs at The Endocrine Witch.
“Why do patients complain?” Tan said. “Then, what can we do when patients complain? Surely, physicians can’t and shouldn’t sue everyone who complains about the care they provide.”
Maynard is a healthcare strategist in Maryland. Cleofas is an educator, researcher, sociologist and nurse. Dualan is the Asia Pacific medical affairs lead for MSD pharmaceuticals.
One of the most common patient laments is why a single drug doesn’t bring an instant cure. Don’t the doctors know what they’re doing?
“Complaints are mostly related to communication,” Lopez said. “Patients say, ‘I did not understand what the doctor said.’
“There’s the cost of meds, or related to the health system itself,” he said. “You hear, ‘I waited for hours to be admitted’ or ‘They ran out of maintenance meds.’”
Beat the traffic
Wait times also top Tan’s complaint list.
“At my clinic, patients complain of difficulty getting a schedule or waiting a long time to be seen,” she said. “We give out appointments, but traffic being bad in Manila, patients show up early.
“Patients understand when waiting times are long,” Tan said. “When it is their turn and they get the attention they need, the wait time is worth it.”
Money — and lack of it — is a big factor.
“Healthcare is often out-of-pocket here in the Philippines, but confinements can be long and costly, draining family finances,” Tan said. “Everyone is anxious, and they want to be updated. Whoever is at the hospital has to update the extended family, too.
“There’s also that concept that the visit is ‘wasted’ when only increased fluids — no antibiotics — is advised,” she said.
Maynard agreed that wait times and getting appointments in a timely manner also are chief stateside complaints.
“Transparency of costs is a big concern,” she said. “Patients often don’t know prices and end up with huge deductibles and out-of-pocket costs.
“Patients complain to nurses more,” Maynard said. “Nurses usually are the first engagement for the patient. They also spend more time with them.”
Perspectives change once inside care facilities.
“In the hospital, patients usually complain about the lack of urgency of getting their needs addressed and see what they perceive as incompetence among healthcare staff,” Cleofas said.
“In the community setting, patients usually complain about how slow the public health programs are rolled out,” he said. “In my previous work in community health and development, the people usually are skeptical about the poor and unequitable services of local-government units.”
State of health also affects those who complain.
“Patients who are really unwell rarely complain,” Dualan said. “They are too unwell to do so, and they are likely already being attended to. It’s the patients — and their caregivers — who are moderately ill or barely ill. There is a selection bias here.
“There was a study in the United States some time ago that doctors who took time to communicate and explain to patients were less likely to be sued — regardless of wait times,” she said.
Good communication helps mitigate long wait times.
“Patients have to feel value in the wait,” Dualan said. “We hear it all the time. This doctor has a snaking long line outside her waiting room and yet patients line up because the doctor is smart and kind.
“We have to unlearn the jargon and speak at the level our patients understand,” she said. “This is an art. No one teaches us those scripts in med school.”
Procedures for handling patient complaints varies by institution — and sometimes are not known to all health workers and patients.
“Procedure depends on the complaint,” Cleofas said. “If it’s worker attitude, we usually deal with the patient personally. If not resolved, we escalate to a higher authority. Larger complaints are usually handled by a grievance committee.”
It’s not unusual to lack a clear procedure to handle complaints.
“Research has confirmed this,” Tan said. “Patients get frustrated when they don’t even know where to submit their complaints.”
Cleofas said the goal is to address concerns before aggression or violence arises. In that light, simply having drop boxes to submit complaints or a shortage of people to handle complaints can make matters worse.
“Usually, there’s no workflow solution for managing complaints,” Maynard said. “In U.S., many healthcare organizations get in regulatory trouble for poor complaint resolution policies and procedures, but they rarely change. They pay a fine and carry on as usual.”
Lopez said complaint procedures should be visual.
“In facilities I worked in, there are mechanisms to address these concerns, but not everyone in the health team knows,” he said. “For patients, notices are often posted in hospital lobbies, but a video would be more apt.”
Patient complaints often are posted on social media, which requires special care and handling.
These complaints need to be answered promptly and effectively. As long as the complaint is there with no good or timely response, the words — justified or not — will reflect poorly on the institution.
“This is where many organizations fail,” Maynard said. “Social media complaints should follow the same complaint resolution path as off-line complaints. You can try to control trajectories by asking the complainant to contact you via email or off-line, but it must be followed up timely.
“In the U.S., healthcare is not like retail,” she said. “You can’t just ‘circular file’ a complaint. There are strict regulations regarding this. The fail of most organizations is that they treat social media complaints differently. This is wrong and risky.”
Tan agreed with the need to quickly acknowledge that the complaint has been received and is being investigated.
“Bring the conversation offline,” she said. “Hospitals can only request and not demand a social media complaint take down. Force is counterproductive.
“If the complaint is related to a hospital or clinic, someone from the institution should at least acknowledge the complaint,” Tan said. “Then bring conversation offline.”
She suggested acknowledgement of the complaint online so bystanders know there is progress.
“Sometimes, the complaints are posted on social media because the usual way was deemed not helpful,” Tan said.
Dualan prefers a dual approach.
“Bring the conversation off line, but maintain an online stance,” she said.
Lopez favors having good relations with lawyers.
“Have parallel efforts: one in the legal department — make sure you have fair and adequate protection under the law — and in social media — by apologizing,” he said. “The difficulty though is that we now have a ‘screenshot’ culture. What may have been taken offline can resurface again. We have to resort to legal means as needed.
“The internet never forgets,” Lopez said. “It may have ostensibly died down, but once something new comes up about the concerned person, the issue can be revived.”
Cleofas prefers these steps to handle complaints on social media:
- Take a screen shot of the complaint.
- The social media manager — or equivalent — of the hospital must reach out to the complainant via private message. Do not leave it to the staff to deal with it alone.
- If complaints go viral, issue public statements.