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As a Primary Care Physician, I Am Also the "Department of Complaints"

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Entering the exam room, I steeled myself for a difficult conversation. Mrs. S. had a new diagnosis of locally-advanced pancreatic cancer. I expected to discuss her fears about the condition, but what she really wanted to talk about was the indignities of her recent hospital stay. 

She had been admitted for abdominal pain after her endoscopic retrograde cholangiopancreatography, and was found to have post-procedure pancreatitis. This medical complication was upsetting enough, but she was appalled by her treatment in the hospital. The staff had been largely unfriendly and rushed. No one explained exactly what was wrong. She kept asking for the biopsy results, but was only told about the malignancy when she pressed for the result as she was being discharged. She was told to schedule a follow up appointment with the oncologist if she had any questions. She was tearful and enraged about her inpatient experience, and said she would never go back to that facility.

My heart sank as Mrs. S. described her ordeal. I would not want myself or my loved ones treated that way. I really wanted to do something to help. However, Mrs S. went on and on with the story and my feelings turned to agitation. The tale was taking up precious appointment time. Very soon I would need to move onto the next patient, and we had not yet reviewed her medication list, talked about how she was feeling now, or discussed anything solid that would actually prove productive.

As is often the case, I felt less like a trusted health care professional, and more like a Department of Complaints.

Early in my career, I did not realize how much of my day would be spent listening to complaints. I should have been tipped off by the conventions of labeling a patient’s "chief complaint" and then working through the "problem list." Fair enough; I was prepared to handle medical concerns. What baffled me was the time I spent hearing complaints and problems about things that were not my fault, that I could not reasonably be expected to solve.

It may begin as soon as I enter the exam room. "How are you?" I ask. Here it comes: "Ugh, the traffic this morning was horrible," or "I can’t stand all the rain we’ve been having," or "My grandkids are driving me crazy," or the ever "hilarious" response of "I’m broke, can you give me a million dollars?"

Those, of course, can be shrugged or laughed off.

More regrettable are the complaints about the practice where I work: "I wanted my flu shot today. I’m upset that you ran out of them," or "I never got the podiatry referral you promised."

While I am not directly responsible for these things, I still feel bad that they happened, and acknowledge that they reflect poorly on me. If the complaint falls in this bucket, I will apologize and promise to relay the concern to the practice manager in hopes of improving policies and procedures.

More baffling but also very common are complaints about other doctors, medical facilities, insurance, or the health system in general. Objections such as "I left three messages but the GI office didn’t call back to schedule my colonoscopy," or "The gynecologist never told me the pap smear results," or "That ER was horrible! I waited forever and then they didn’t even take an X-ray."

Of course, most heartbreaking are serious grievances with the quality of their health care: the prescription costs that are too high to allow the recommended treatment, the clinicians who don’t listen or explain. Too often, patients recount a true medical trauma, maybe even a severe complication or episode that happened decades ago.

Why are these stories directed at me?

I have a few theories.

In a culture where the correct answer to "How are you?" is "Great!" I may be one person who feels acceptable to complain to. My patients may not want to worry or burden their family with these negative thoughts. My patients may be looking for a reality check, to confirm if their outrage is justified, if their expectations for better treatment are reasonable. (And yes, very often, I agree that they are.) 

Mostly, I have come to realize that for many patients, as their primary care physician, I represent the whole of the health system. I am the small part that is accessible, that will listen. Perhaps they think I am somewhat complicit in the entire mess? (I suppose that to some extent, I am.)

I often think this is the worst part of my day, being regaled and berated for irritations or traumas that I did not directly inflict. It can be grinding to listen to and makes me feel helpless. I went into medicine to fix problems, and these are often situations that I can not fix.

So, what can I do?

I can let the patient get the feelings off their chest so they can move onto other things. I can rifle through my imaginary tool box and see if there may be a small way I can tinker with the situation to ease it a bit.

The truth is, I do have power within the system that the patient can not access alone. I can call the back line to the specialist’s office, track down the test result, or stop referring to the facility or hospital that treated my patient without respect. I can learn what the patient values (timeliness, communication) to avoid repeating the mistake in my own practice. I can listen and hopefully reestablish trust. Like it or not, to some extent, I am an ambassador for the entire medical system. By providing compassion and hopefully a better experience, I can help the patient build back confidence in the overall care they will receive.

It’s important to not let the patient pull me down the rabbit hole of negativity. Of course I have my own gripes with the system, but the exam room is usually not the place to discuss it. I choose to use the brief time to validate and uplift the patient. I might say "I would feel the same way," or "You did the right thing."

No matter how much the patient complains, I try hard to not take it personally. After all, they chose to come in today to see me.

One of my favorite responses I learned from the genius parenting book "How to Talk So Kids Will Listen & Listen So Kids Will Talk" by Adele Faber and Elaine Mazlish. It’s the "I wish" statement, and it works on people of all ages. "I wish I could wave a magic wand and get the MRI authorization right now," or "I wish you never had to go through all this." This seems to legitimize the patient’s feelings even while acknowledging that I don’t actually have real power over the situation.

Lastly, it’s important to help the patient and ourselves look for the good, not just the problems in the health system. One way I do this is to up-talk the people that I trust to treat the patient well: "Janita will see you now to take your blood, and she is great," or "I have an idea for another cardiologist if you want a second opinion. This one will really take her time to explain everything to you."

A story like Mrs. S’s can really stick with you and get you down. It’s important to not ruminate on the negatives, but to remain alert to all the positive interactions. After listening to complaints all day, a smile of gratitude seems all the sweeter.

As much as I am baffled by all the complaints, I am often pleasantly surprised by the smallest things that can make a patient truly grateful: a refill, a recommendation, a handout, a commiserating ear. And nothing makes me feel better than seeing my patient walk away from my "department of complaints" with a nod of satisfaction.

What's a complaint you've fielded recently? What's one you were able to solve? Share in the comments.

Melissa Schiffman, MD is a community-based primary care physician who practices in Suburban Philadelphia. She enjoys books, birds, gardens, and word nerdery. Her favorite medical term is "borborygmi." Find her on Twitter at: @MSchiffmanMD. Dr. Schiffman was a 2022–2023 Doximity Op-Med Fellow, and continues as a 2023–2024 Doximity Op-Med Fellow. All identifying information is shared with permission.

Illustration by Jennifer Bogartz

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