Minimize difficulties associated with State Medical Board complaints

A physician in our community recently received a letter from the State Medical Board informing her that a complaint had been filed by one of her patients and that she would have to respond to the grievance in writing. The substance of the complaint was that when the patient first registered at the office front desk, a face photograph was taken which was placed in her medical record. The receptionist explained that this was the policy of the office to help prevent identity theft. The person was not mollified and claimed that this made her “feel like a terrorist”. Therein was the sum and substance of the complaint, which was filed with the State Medical Board.

Although this sounds pretty frivolous, the physician needed to prepare a written response and to inform her malpractice carrier when re-applying for insurance coverage. The “case” is still pending. The office continues to use photo identification as a means of preventing identity theft.

Last year, I received one of these fear-provoking documents from the Board asking that I respond to a complaint by a 26-year-old weight lifter with uniform acneiform papules on the trunk who was insulted that I inquired whether he had taken anabolic steroids in the recent past. After a fair amount of angst and letter writing on my part, the case was dismissed.

These anecdotes have a few things in common and help to explain why oversight by an administrative board is not necessarily the most efficient means of identifying those practicing below the community standard of care. In both instances unhappy patients could bypass any dialogue with the treating physician and appeal directly to a governing body that automatically begins an investigation of the alleged offending practitioner.

In our state, the statute requires that all complaints must be answered by the physician regardless of the merits of the issue. These illustrative cases also demonstrate what all of us know - there is a general lack of trust between the patient and the care giver. The pressure of caring for too many people per day makes it difficult to take the time to allow a patient to vent his anger and disappointment in the office rather than at the level of the State Board. In the two cases cited here, the patients were new to the practices and there was no opportunity to form any type of rapport in the few minutes allocated to the appointments.

One might ask what real difference it makes if an irate patient complains to the Board. In fact, it can become a very big deal. Unlike a malpractice suit, an adverse outcome could lead to a suspension of one’s license to practice medicine and an end to one’s professional career.

Communication is key

It is quite clear that we cannot please all patients all of the time. Unrealistic expectations, errors in judgment, bad luck and just plain “bad days” are all a part of the complex nature of medical practice. With that in mind, here are some tips for what can one do to minimize the problems associated with a complaint to the Board:

• Try to recognize an adverse interaction while the patient is in the office and attempt to defuse it before he has a chance to fume at home and decide to ruin your day with a Board complaint. When I see an obviously annoyed patient I will often say something like, “It appears that you are not happy with the care that you are receiving today. What seems to be the problem and what can I do to make things right?”

• This sometimes produces a pretty vicious rant about what a bad and incompetent person I am. I do not try to defend myself (it usually does not do much good anyway); but rather, I apologize for the bad experience that the person has endured. I have never had such an encounter result in a complaint against me to the State Board. Most patients just wish to be heard and to express their feelings. Once this is done, the situation seems to rapidly dissipate.

• Don’t take it personally if and when you receive the accusatory letter from the Board. The vast majority of these are completely without merit and have little or nothing to do with your skills as a physician. When responding to the allegations, avoid becoming emotional or defensive and simply present the facts as you see them, including the rationale for the specific care that you delivered.

• In the event that the complaint is of a serious nature where real harm befell the patient and there is some question as to your culpability, by all means you should consult an attorney experienced in interactions with regulatory agencies. That individual can help you prepare rebuttal documents and can accompany you to any hearings that may ensue.

Occasional irate patients are a fact of life of modern medical practice. We must all attempt to satisfy our patient’s needs as much as possible. Sometimes it simply does not work out. Try not to let the dreaded communication from the Board annoy you too much (although I must admit that it ruined my day). When called upon to defend your actions, do so in a professional manner. It will almost always conclude in your favor.