Будянский - главная ›› Чужие посты ›› Жалобы пациентов

Жалобы пациентов

2 3 4 

Интересная статья на английском. Жалобы пациентов серьезно изучают.

Patients‘ complaints about medical practice

Ann E Daniel, Raymond J Burn and Stefan Horarik

To survey complainants‘ experience and the outcome of lodging a complaint about medical treatment.
Design and setting: Random sample survey. A 32-item questionnaire was sent to 500 complainants by the New South Wales Health Care Complaints Commission (HCCC), and responses were returned reply-paid to the university.
Participants: 290 people with complaints finalised by the HCCC between February 1996 and August 1997.
Outcome measures: Profile of complainants and doctor involved; type and place of incident; complainants‘ emotions at the time of the incident and at the conclusion of the complaints process; outcome of complaint, and satisfaction with outcome and intention to take further action.
Results: After excluding non-medical complaints, 290 of 314 questionnaires returned were analysed, giving a response rate of 63% (314/500):

    * 64% of complaints were about clinical care, and the remainder related to rudeness or poor communication (22%), and unethical or improper behaviour (14%);
    * 70% of complainants were women, and 44% of complaints were on behalf of another person;
    * Complainants had a high socioeconomic status, and 60% were currently in paid employment;
    * More than half the incidents occurred in doctors‘ consulting rooms; 87% of the doctors involved were men, and over half were general practitioners.
    * 37% of complaints were dismissed; 21% of complainants did not know the outcome of their complaint, and 40% believed that the doctor had been disciplined.
    * Most complainants were dissatisfied with the outcome; a quarter stated that they would sue, but 70% would do nothing further.
    * All but two complainants would never consult the doctor involved again.

Conclusions: Most of the respondents were not satisfied with either the process or the outcome. Typically they wanted stronger measures taken. Only a few wanted compensation; more wanted acknowledgement of harm done; and most wanted the doctor punished.

Introduction    Patients may make a formal complaint if they believe that good medical practice has failed them. The implications of these complaints for the medical profession in the United Kingdom, the United States and Australia have been assessed recently.1-5

Although the medical profession has been assiduous in self-regulation, governments in many countries have responded to well publicised concerns about the efficacy of professional self-regulation by establishing complaints handling bodies. For example, in New South Wales, the highly public failure of the healthcare system exposed by the Royal Commission into deaths and injuries as a result of psychiatric treatment at the Chelmsford Private Psychiatric Hospital6 prompted the NSW Government to establish a Health Care Complaints Commission (see Box 1). In Australia, these units have been developed under the auspices of State health departments, and in some States have been accorded statutory independence.

The impact of complaints on doctors has been studied;9,10 less researched are patients‘ perspectives. One study of litigants11 explored the views of patients suing in 227 medical negligence cases. Focusing on standards of care, the authors argued against proposals for no-fault compensation and concluded that, while litigation may provide compensation and possibly some explanation, it does not address litigants‘ concerns about standards of care and accountability.11

Our study takes up such concerns about care, competence and responsibility as voiced by patients who bring a formal complaint, but usually do not become litigants -- a somewhat different population, but one which is likewise disgruntled and distressed about a medical incident. We examined the experience of healthcare complainants, and their satisfaction (or otherwise) with the process and outcome of bringing a formal complaint.

Methods    We surveyed people whose complaints were finalised by the NSW Health Care Complaints Commission (HCCC) during the 18 months February 1996 to August 1997. The HCCC agreed to address our survey package to complainants at the time of closing each file. This ensured that complainants‘ privacy was maintained, and that respondents answered questions about a process, often lengthy, which had just concluded.


The 32-item questionnaire asked for a description of the incident leading to the complaint; where the incident occurred; the specialty, sex and approximate age of the practitioner; demographic details of the complainant (who was not necessarily the patient); feelings of the complainant at the time of the incident, at the time of making the complaint and subsequently; their expectations of the outcome; and whether they intended to take the matter further. The survey instrument was piloted and revised. The survey packages, 500 in total, were mailed intermittently from the HCCC office, a procedure which gave us only remote control over the distribution.

Statistical analysis
SPSS software was used for the analysis.12 The results are given as the percentage of respondents answering particular questions, and Pearson‘s 2 tests of independence were used to determine the significance of the association among reported (dis)satisfaction, nature of the incident, demographic characteristics of complainants and practitioners, respondents‘ expectations and the outcome of the complaints.

Ethical approval
The Ethics Committee of the Health Care Complaints Commission requested some minor changes to the questionnaire and then approved the study in July 1995. At that time, there was no requirement for ethical approval for such surveys by the University of New South Wales.

The Results of the analysis of the survey are shown in Box 2.

    Patients who make formal complaint continue to view very seriously the incident which prompted the complaint. They recall vividly their negative emotions about the incident, although at the time most were glad of the opportunity and satisfied with the procedures for lodging a complaint. Their dissatisfaction mounts, as finalisation of complaints typically takes many months, even years, and by the time of our survey, when the file was closed, most were dissatisfied with the process and the outcome of making a complaint. Almost a third of the respondents declared that they would take the matter further: 26% intended to sue, and 4% would inform police, and appeal to the Minister for Health. Despite the common view that most people who file a complaint simply want an apology or acknowledgement of harm,15 such a response would have satisfied only 16% of complainants.

Complainants‘ expectations seem to be at odds with the role of the HCCC and cannot be met by its statutory functions. Its role is protection of the public, not punishment or restitution.

That only five respondents‘ complaints (1.7%) had been successfully conciliated is surprising given the Commission‘s vigorous commitment to this course of action. The 1996-97 HCCC report records successful conciliation in 50 of the 82 complaints in which this was attempted, and, in 1997-98, 74 complaints were resolved through conciliation and a further 278 by "direct resolution". These latter had been judged as important but to "not warrant investigation or conciliation".16 The complaints of our five respondents which had been settled by conciliation involved poor communication on part of a specialist (3 cases) and refusal to attend by general practitioner (2 cases). Two were satisfied, and three were dissatisfied, with the process. The numbers were too small for further analysis.

Our respondents were better educated and of a higher occupational status than is typical of the population as a whole, perhaps because people of higher occupational status are more likely to respond to surveys. However, we found no significant association between employment status, sex, age or occupation of respondents and their report of dissatisfaction/satisfaction, expectations of the outcome, and intention to pursue the matter in the courts. The one pointer to intention to sue was the nature of the event. Complaints about clinical incidents are not more likely than those involving communication or personal ethics to bring disciplinary action, but they are significantly more likely to lead to litigation.

The health consumer‘s disappointment, anger or outrage over inadequacy, incompetence or failed ethics on the part of health practitioners can find voice through the powers of complaints units such as the NSW HCCC. Its powers of investigation, referral, prosecution, conciliation, and accountability to Parliament protect the public and monitor health service standards. Perhaps the increase in complaints about health services signals a rising consumerism and disenchantment with professions generally. Robert Hughes‘ diagnosis of "a culture of complaint" that engulfs daily life is widely accepted.17 The known availability of effective complaints mechanisms certainly gives legitimate outlet for discontentment.

Our survey indicates that people are aware of their rights as consumers and are glad to have ready access to avenues of complaint. They felt that initiating the complaint was the right thing to do, but they were often disappointed with the outcome, because their expectations were at variance with what does, or indeed can, ensue

2 3 4