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06-02-2012 | Legal medicine | Article

Reported patient complaints only ‘the tip of an iceberg’

Abstract

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MedWire News: Official complaint records provide an incomplete picture of patients' experience of adverse events, as a number of patients abstain from reporting their complaints, according to research published in the British Medical Journal: Open.

Responses to a survey conducted by Maja Wessel and colleagues at the Stockholm Center for Healthcare Ethics, Sweden, showed that of the 867 respondents with complete/relevant data, 159 (18.5%) had a legitimate reason to file a complaint but abstained. Official complaints had been filed by only 23 participants (2.7%).

The participants were all residents of Stockholm, with a mean age of 49 years and 58% were women. They completed a questionnaire in terms of their experience of healthcare, negative encounters, trust, and complaints made to the Patient's Advisory Committee.

While 60.3% of the respondents had a positive general experience of healthcare, analysis showed that patients whose general experience of healthcare was negative (34%) were more inclined to file a complaint. The researchers also found a strong correlation between a general negative experience and low trust in healthcare. One-third of the participants who had cause to file a complaint but chose not to say they had low trust.

The reasons people gave for abstaining from filing their complaint were subdivided into the following five themes: "weakness," "futility," "lack of knowledge" (about how to complain), "mercifulness," and "other action taken." The most common reasons given for not filing a complaint were "I did not have the strength," given by 39 participants, and "I did not know where to turn," given by 18 participants.

Another common reason, given by 17 participants, was "It makes no difference anyway," therefore "implying distrust regarding either the ability or the willingness of healthcare to actually take notice of and learn from the complaints," the researchers say.

Some respondents chose not to complain due to fear of reprimands, such as receiving worse care or having their treatment withdrawn, a result the researchers say they found "alarming."

"Comparing the number of respondents who have filed a complaint with the number who have not but who think they had legitimate reasons to do so, we found a significant difference, indicating that the complaints filed show only the tip of the iceberg," write Wessel and team.

They conclude: "In order to develop and improve the quality of healthcare encounters and services, by assuring critical feedback, it is important that healthcare providers offer more information and support to patients who want to make complaints." However, they also call for further research.

By Chloe McIvor

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