Complaints in Medicine

There should be some understanding of the downside of the process. Filing a complaint is not a 2-hour-job done one evening. It ends up taking months of work to gather the information required by agencies like state medical boards, and commonly patients cannot get the information required. What they do get frequently they cannot decipher and cannot find anyone who will do that for them.

An injured woman with a full time job, two kids and no husband is struggling just trying to get treatment for the injuries, which takes an extraordinary amount of time because, without her understanding this, no one will diagnose iatrogenic injuries. So it is a task that never ends. And one of the things required by the state medical board is a document showing that a physician has stated that the injuries were caused by the specific operator in question. 

She is overwhelmed by her own health care needs, taking care of her children, and keeping her job, and now she has been told that she needs to identify the witnesses in her complaint. She calls the hospital but they say they have no way of figuring out who was in the operating room. 

She starts calling lawyers trying to find help getting that information out of the hospital, but no one will take her case. Let's say that in some online chat forum she gets lucky and gets a response from someone who tells her to take time off from work immediately to visit that hospital during business hours, go to the records department and get a copy of her post op report before someone alters it, which happens when they suspect a grievance might be filed.

She has been told to get that report and see who signed it because everyone who was in the OR was supposed to sign it. So she does, but the signatures are illegible, which is normal. The state medical board will dismiss it for lack of evidence if she does not figure out who those signatures belong to. The hospital says they cannot read them either. 

She lives in a large city with a lot of lawyers. So she gets out the phone book and telephones every single one of them. Many will have to call her back. Her work hours are continually interrupted by phone calls being returned from lawyers and doctors and records departments and others she has contacted. In the end not one of the lawyers will help.

This is just one of the many tasks consuming the time of the injured person who is suffering and busy and needs to be tending to other things and is supposed to file this report because it is thought that if enough people complain about the same care giver, a licensing board might do something.

Filing a complaint is not without its downside. And the things state medical boards (which is the example I'm using) require are things that cannot be gotten by a patient. Cases hinge on getting documents like one from a physician stating that the injuries definitely were caused by a specific other physician. A patient cannot get that. 

We are not going to solve the problems for patient safety by maintaining naivete. The patient community needs to understand the extent to which they have no advocates when things go wrong. State medical boards advocate for care givers, not patients, in these matters. If we don't get in tune with the real world we waste everyone's time pursuing fantasies instead of solving the real problems.

My problem with the conventional wisdom about what to do to complain about adverse events in medicine is that it promotes wasting time chasing a fantasy. Elswhere on this site I tell people that I too hope they file a complaint, but I try to prevent their burning themselves out figuring out how little there is to be gained and how much their caregivers are going to work against them.

To get anywhere with a complaint they need to understand up front that the delays and obstacles that will be put in their path are there to defeat them, and that they need to understand that so that they can try to figure out how not to let their caregivers do that to them while simultaneously creating records that will make their complaint even less likely to succeed.

Patients think that their primary care physician will help them. They need to understand that they need to look at the records their primary physician creates to see what gets written down - frequently the exact opposite of what the patient reported.

They need to understand why none of the physicians the patient is sent to seem to be able to find the injuries and what to do about that before they are delayed for so many months by the series of unproductive appointments that by now the witnesses who were in the OR won't be able to recall anything.

Injured patients should understand that historically licensing agencies don't do anything no matter how many patients file complaints about a specific care giver. Look at the cases of abusers and serial killers, which are the only kinds of cases we can find out about. Even when it rises to that level of a problem, the agencies don't do anything as a result of the complaints of patients.

The level of naivete about this subject is so great it cannot be addressed on a single web page. But it is damaging to the patient community and the goal of making them safer to spread false hope and unwarranted faith in institutions and processes. It wears out injured patients and misdirects the thoughts and efforts of safety advocates. 

Unfortunately, it makes enemies, and no friends, to point this out. Everyone is so busy making "nice" with care givers, instead of figuring out when they are not nice - a necessary thing to figure out if we are going to work on real world problems rather than fantasies.

You are their problem

Your care giver has to be there for the next patient. That is not you. You are in the way. You are the enemy and will be dealt with as such. They don't believe your claims. They don't record them. They will record lies they make up saying that they could not understand what you were talking about, that you seemed confused and paranoid and all manner of pejorative statements that no objective observer would conclude. And they will say that you reported that you have had these injuries for many years but only just now are complaining about them in order to be able to blame a care giver for them. The state medical board requires that you get a document from a care giver pointing a finger at another care giver, and what would be sent to the state medical board for you is a document saying the opposite.

If you don't know that this is what is happening around you, your misplaced faith in the care giving communty to help you will prevent you from finding a way through the medacity and subterfuge to the help you need.