Complain About a Doctor or Other Healthcare Provider

Doctors Behaving Badly

Doctor. Adam Berry / Stringer / Getty Images

Hundreds or thousands of mistakes are made by doctors and other medical providers every day. In addition, there are doctors who behave badly; from being crude, to acting drunk, to outright fraud.

Patients complain in the ways that are most convenient: to family members, friends, co-workers. But that kind of complaint only begs for an ear and some empathy. What it doesn't do is demand change or that the perpetrator is disciplined, or taught a better way to do things.

If you want to make a complaint about a doctor or other provider in hopes that it will result in some sort of discipline or change, then it will require a more formal type of reporting.

Is Making a Complaint Worth Your While?

Whether or not it's worth your time to make a formal complaint depends on what you expect the outcome to be.

It's highly unlikely that one complaint about a doctor will result in any sort of change or demand by authorities, no matter how heinous that doctor's actions. Patients report their great frustration that they filed formal complaints but never heard anything back from the organization they complained to. That is the norm. And since you have no idea how many other people have complained about that one doctor, then that should be your expectation - that nothing will happen and you won't get a reply from those you complained to.

However, when those groups who do receive complaints begin to see patterns from complaining patients, it's a signal that something does need to be done. Depending on the group, a large file of complaints may result in disciplinary action ranging from a warning letter to the removal of a doctor's license to an arrest.

You may also consider it to be your responsibility to let authorities know about your bad experience without expecting an individual response. Ask yourself: Is what the doctor or provider did to you something that, if repeated, would cause harm to another patient? If so, then reporting that behavior may eventually prevent that provider from doing something bad to someone else.

Therefore, in answer to whether or not a formal complaint is worthwhile, the best approach is to manage your own expectations. Know that you will probably get no individual satisfaction from a formal complaint, but that you will have helped establish a pattern of problem behavior and perhaps prevented someone else from suffering at the hands of that provider. That should be all the reason you need.

When Should You Formally Complain About a Doctor or Other Medical Professional?

Patient sitting on bed in hospital
Portra Images/Getty Images

Everybody makes mistakes - even doctors and other health professionals. The biggest problem with medical mistakes, and the point that makes medical mistakes a bigger problem than others is that they can result in the loss of life, or the loss of quality of life.

That means we need to make an assessment of just how egregious the error was before we make a formal report about it. And that's the line I draw. Ask yourself, did this doctor's behavior result in a loss of life, or loss of quality of life? If the answer is yes, then you have reason to make a formal complaint.

Some examples of how to apply that rule:

Example 1: Your doctor is arrogant, condescending, and threatens to throw you out of his office because he doesn't like working with a patient who looks for health information on the internet.

In this case, no, this is not an occasion when making a formal report would be important. There's been no real harm done other than the insult. If the doctor is that arrogant, make online reports about his arrogance, tell everyone you know to avoid him, and find yourself another doctor. Of course, if his arrogance led to a medical mistake, or if you felt abused or intimidated, then yes, you might want to report him. If you still need to work with this doctor, then read this advice for dealing with an arrogant doctor.

Example 2: Your spouse undergoes gall bladder surgery and you take her home from the hospital two days later. Soon after, you find yourselves in the ER because she is running a fever, and you learn she developed sepsis because her bile duct was nicked during surgery. But nobody said anything! You had no idea. After an extended hospitalization, your spouse returns home and recovers over time.

This case is definitely worth reporting for at least two reasons: First, your spouse required extended hospitalization, your insurance is being billed, and you are expected to pay your portion out of pocket. Whether or not you will end up with a lawsuit over this problem, you want to be sure you file complaints about this doctor. And second, of course, the fact that the problem wasn't reported to you is a signal that it's being covered up; your complaint will force transparency.

Example 3: You receive bills from your doctor or hospital and they seem high. You contact the insurance company and they help you enough for you to realize you have been billed for services you know did not take place. You contact the doctor's office and eventually they remove the charges. But then it happens again, and again.

This is one way doctors commit insurance and Medicare and other forms of billing fraud - by upcoding, upcharging and balance billing. There can be some big rewards from the government if you help them uncover fraud, so by all means, you'll want to report it.

Before You File a Formal Complaint About a Doctor or Other Healthcare Provider

Remember that everyone has an occasional bad day. But a pattern of mistakes, arrogance or misconduct which have resulted in detriment to a patient may mean that doctor or other provider should be reported to someone who can help affect change, or remove that provider from practice.

With that in mind, here are the steps to take before you make a formal report:

  • Complain directly to the doctor who created the problem. Be very specific about what you expect, then give him time to follow through. If he does follow up with you, then you may not need to file a more formal complaint. Here are instructions for making that complaint directly to the doctor.
  • Contact the doctor's practice manager and make a verbal report, followed by a letter or email that spells out your complaint and your expectations as discussed by phone.
  • Write an online public review of that doctor. Others will see it and consider your opinion before they choose that doctor.
  • Be aware that there will be ramifications if you make a formal complaint and the doctor knows you were the source. That may not matter to you; if you can find a doctor in another practice to help you, then the reported doctor's response won't be a problem for you.
  • Do not become that patient who complains about every doctor she meets. Word goes around among providers about patients who seem bent on destroying any doctor's reputation, and such patients have been known to be blacklisted.

    In that same vein, here's a reality check for you: If every doctor seems to be a problem to you, then it's probably your expectations that need to be adjusted and not necessarily the doctors' behaviors that are the problem.

What Information Should You Supply in the Complaint?

There are two types of complaints you can make.

• Some complaint mechanisms are forms that need to be filled out, usually online. The content needed will be dictated by those forms.

• In other cases, you may need to write a letter. The letter should be concise, objective and actionable. Here's how:

  • Short and Concise: No more than a few paragraphs with short sentences, all fitting on the front of one printed page. Be specific about your points, perhaps using bullets, using short sentences. If you ramble or carry on with information that can't be used by the person you complain to, you run the risk of having the complaint-receiver simply toss your letter into the trash.
  • Objective: Leave your emotions out of the letter. Emotions get in the way of the actual behavior itself. Frankly, the people who read your complaint don't want to know how you feel about it; rather they need to know exactly what the practitioner did that was wrong. Your emotional distress is important - it's the signal that something went wrong. But save those emotions for your friends and family and stay as objective as you can in your report.
  • Actionable: Tell the reader exactly what you expect to happen next. ("I want an apology from Dr. _____ and I want him to take a course in how to do gall bladder surgery.") As previously stated, you are not likely to see these outcomes, but it doesn't hurt to ask.
  • Be reasonable about your request. If you tell them you expect them to yank the doctor's license, then you probably won't get very far. Your best goal is to help establish a pattern of problem behavior. So, instead, ask them to start a file or add to that doctor's file, and that you want to support them when they review that doctor in the future. You'll sound very reasonable, and when they begin to see patterns, they may take action.
  • Be sure you include your own contact information. If you don't, they are likely to toss your complaint. After all, it could be a competitor and not a real patient. Including your contact information makes it easy for them to report back to you, or to get in touch to ask more questions.

If all this seems a little daunting, and you aren't sure about your letter writing abilities, ask a family member to help, or consider hiring a patient advocate or business writer.

When you write up your complaint, if possible, set it aside for a day or two. When you pick it up again, you'll remember information you forgot to include, or you'll decide to reword something to make it more understandable. Especially when our emotions are tied to our message, it's important to gain some clarity. Waiting a day or two can provide that.

When you have finished your letter or filling out the online form, be sure you make a copy for your own records before you hit SUBMIT or put the letter in the mail.

Finally, plan to follow up with whom you complained to, but not until at least one month has gone by. Even if you are told they haven't or can't do something to address your concerns, it doesn't hurt to go on record that you are keeping tabs.

Where Can You File a Formal Complaint Against a Doctor?

The answer to this question depends on where you live. Pick and choose from the following suggestions according to what makes sense about your complaint.

You can make your complaint in one or more places. However, you should limit the number of reports you make about one doctor. Reporting a problem provider shouldn't be a personal vendetta. It should be a way of making others aware of the problems caused by this particular doctor.

  1. As mentioned previously, make a complaint directly to your doctor or your doctor's practice manager first. In this case you will do so hoping that you can mend the relationship and move on.
  2. Even if the problem didn't take place in the hospital, find out what hospitals your doctor is affiliated with and complain to two of their personnel: 1. whomever is in charge of patient relations and 2. whomever is in charge of risk management. Call the hospital to ask for the names and mailing addresses of the people who hold those positions. Don't bother the hospital president with it, nor the hospital's board members. They don't know what to do with the complaint and it will either sit on their desks or be sent to one of the other two people just mentioned.
  3. Complain to your local medical society. There's probably not much they can do, but if they begin to see a pattern about one doctor from many sources, they will contact the doctor and try to suggest some sort of correction. Find your local medical society by searching for the phrase "medical society" and either your city, county or region name.
  4. Complain to the medical board the doctor is certified by. You can tell which boards those are by looking up your doctor online, then finding the information about his training and certifications, such as "Board Certified by _____" From there you can find a master list of boards here. Some boards have their own complaint procedures listed on their websites. If the board your doctor was certified by doesn't have a formal complaint procedure, then find an address on the CONTACT US page, and ask that it be delivered to someone who looks at disciplinary or revocation issues.
  5. Complain to the Joint Commission.  The Joint Commission (formerly called JHACO) is the organization that accredits hospitals and that works toward improved safety for patients, among other hospital quality efforts.  If your complaint is associated with a hospital stay, you can submit a complaint online or in a letter.  They promise to keep your identity a secret, but to check out your complaints.
  6. Complain to your state's professional licensing bureau, medical board and/or health or insurance department. Each state handles complaints about medical professionals differently. You can find a link to a list of state medical boards here. Contact them first, tell them you need to complain about a medical professional, and they will be able to refer you to the right department.
  7. If you have Medicare, and the problem you have to report is related to billing fraud, you can follow the procedure provided by CMS for Medicare fraud. If you live in Florida, you have an extra means for making a report which is found on that same web page.
  8. There are doctors who oversee drug mills, or molest children, or commit many other kinds of crimes. If you suspect a doctor of doing something illegal, you'll want to file a formal complaint with your local law enforcement - your police department or sheriff's office.
  9. If all else fails, and the report you want to make is about a death or lifelong debilitation that took place, then consider contacting the media. The truth is, it will be extremely difficult to get the media to pay attention unless a lawsuit has been filed and won, or the behavior is sensational enough to draw in listeners or viewers. However, like reporting to other organizations and agencies, if they begin to get reports from many people about one doctor, they may be the ones that compel other groups to take a look. It's not unheard of that the media got involved, and then a doctor was arrested or had his license revoked.
  10. Finally, if the problem is related to the death or lifelong debilitation of a patient, then it may be time to file a lawsuit. Touch base with a number of medical malpractice plaintiff attorneys. They will give you a reality check on whether your case has any chance of succeeding in the court system.

What If the Doctor Gets Angry or Upset?

Nobody likes to be caught doing something they should not be doing. And, if it ends up dinging an arrogant ego, costing them money, or they end up in a lawsuit or with some sort of sanction, then they will be even more upset, of course.

When patients are afraid to report problems, I call it "the waiter will spit in my soup" syndrome. It's the fear that the doctor won't do his best to help you or will somehow provide substandard care to you because you reported problems.

It's entirely possible that if you complain to any sort of authority other than the doctor or his or her practice manager, then the doctor will get angry. It's a risk you take. That's one of the reasons you should complain to your doctor first, before you take it elsewhere, in hopes the problem can be worked out. There are also ways to repair the relationship afterwards.

But beware. Your doctor may refuse to see you again. It is not uncommon for a doctor to dismiss a patient she no longer cares to work with.

If you ever plan to see that doctor again, then measure your complaint process against what will happen if he gets upset.

Your best bet is to line up a new doctor, making sure the new doctor has access to all your medical records, before you complain about the one who has created problems for you.

Continue Reading