■ Safety of care:
Improving patient safety and reducing risks
How physician-patient interpersonal dynamics affect likelihood of patient complaints
5 minutes
Published: March 2025
The information in this article was correct at the time of publishing
A 2024 study produced by CMPA 1 reveals significant findings on the factors that increase physicians’ risk of receiving medico-legal complaints. The study investigated patients’ perceptions of interpersonal dynamics with their physicians, as expressed by patients in regulatory authority (College) complaints they had filed about the care they received to treat a life-threatening medical condition: sepsis.
While the patients in this study had survived their sepsis episode, they nevertheless lodged complaints about their physicians. These complaints revealed perceptions held by the patients about their medical care and offers insight into underlying interpersonal dynamics that led to the complaints. This article highlights the perceptions and feelings that patients shared in their complaints, with a view to helping all physicians—regardless of specialty or practice setting—to enhance these skills.
Perceptions of quality of care
Patients can have different expectations of the care they are receiving. They may become dissatisfied when care is seen as rushed or inadequate. Similarly, patients may be more likely to complain when they perceive insufficient concern.
A patient’s cultural background and previous experiences may also play a role in a patient’s interpretation of clinical symptoms and approach to healthcare. By missing clues or misunderstanding a patient’s cultural viewpoint, it is possible for physicians to unintentionally offend, and thereby place a patient’s adherence to treatment and health outcomes at risk. Through an inquisitive, non-judgmental, and culturally sensitive approach to interactions with patients, these issues can potentially be avoided while patients feel safe to express their viewpoints, values, and preferences.
Effective communication
While medico-legal complaints often stem from various factors, effective communication—and perceptions of respect and understanding—is one of the most influential factors in reducing the likelihood of complaints. Specifically, perceived lack of active engagement and empathy, transparency and clarity, and respect and demeanor play a role in patient complaints related to communication.
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Active engagement and empathy are communication skills that include focused attention and reflective listening. Beyond merely hearing the patient’s words, this approach encompasses a deeper level of comprehension and empathetic interaction.
Without engagement and empathy, patients may feel unheard, dismissed, or rushed during important discussions—especially when receiving bad news about their health. For example, a patient felt that their physician moved too quickly from informing them about the need for an amputation to choosing a surgical date. The patient didn’t feel that they had time to process the distressing news, and that they were hurriedly presented with a consent form.
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Transparency and clarity involves open, honest, and clear communication that empowers patients to make informed decisions about their health. This includes obtaining a patient’s informed consent, that is, their voluntary acceptance of a proposed medical plan.
Without transparency and clarity, patients may perceive that they were not given sufficient information about their condition or interventions, or that the physician did not confirm the patient’s understanding of the treatment plan and potential risks, and give the patient the opportunity to ask questions. For example, a patient experienced chest discomfort but felt that their physician was strongly suggesting a referral to see a psychiatrist. They were reluctant to seek clarification from their physician, fearing a negative reaction from them.
When unintended health outcomes occur, patients might perceive that their physician was not transparent, or that their physician had given overly optimistic news or false hopes about treatment outcomes. For example, a patient was told by their surgeon that an injury that resulted during a laparoscopic surgery was minimal, but the patient was later told that it was a significant injury, which was verified by the doctor who performed the repair surgery.
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Respect and demeanor reflect core values of the medical profession. When these qualities are lacking (e.g. insensitive language, rude tone, patronizing attitude), patients might feel offended, judged, or labeled. For example, a patient reported being labeled "drug-seeking" when seeking medication for chronic pain. They felt this unfair assumption and labeling affected their emotional well-being.
Ethics
Ethics is a key part of ensuring that the care patients receive is in their best interest. Ethical practices include involving patients in the decision-making process and protecting patient privacy.
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Patients’ involvement in the decision-making process acknowledges the importance of their unique viewpoints, values, and preferences. For example, when a patient told their treating physician they did not want to have surgical procedures, the physician laughed and questioned the patient about how their views might have evolved.
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Confidentiality and protecting patients’ privacy involves keeping a patient’s personal and medical information secure and shared only as necessary or with patient consent. For example, a patient reported that their physician sought information from untrusted sources and shared incorrect information with other physicians that ultimately affected how the patient was perceived and treated by other healthcare providers.
The bottom line
When patients feel that physicians fail to make a meaningful and satisfactory connection with them, patients may be motivated to lodge a medico-legal complaint. The likelihood of patients making a complaint is reduced when they perceive genuine care and concern, compassion, honesty, and acknowledgment of their values and preferences.
Additional reading
Reference
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DISCLAIMER: This content is for general informational purposes and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. Your use of CMPA learning resources is subject to the foregoing as well as CMPA's Terms of Use.
