Complaints Filed by the General Public against the Director of the Rehabilitation Department at a Medical Center

Letter to the Editor

Lodging a complaint against the Director of the Department of Rehabilitation within the framework of a medical center is usually due to the unwillingness of the director to meet patient demands or family requests. Confrontation between the parties may occur face to face, in a telephone conversation or through a third-party. Due to the dissatisfaction of the director’s response to the demands of the person lodging the complaint, a request is usually made to the medical center’s administration and from there is directed to the Unit for Public Complaints / Customer Relations existing at that same institution.

Between the years of 2010 and 2014, a total of 17 complaints were filed against the Director of the Department of Rehabilitation at a large medical center in northern Israel.

The reasons for those complaints were:

1. Unwillingness of the director to admit the patient for rehabilitation treatment within the framework of his department for professional reasons (n=11), for example:

a. advanced age which justified referral of the patient for treatment within a geriatric framework (n=4).

b. advanced age + dementia (n=2)

c. advanced age + prohibition to bear weight on the injured leg (n=1)

d. lowest arousal level after sever brain injury 4 months from the time of accident (n=1)

e. prohibition to bear weight on the injured leg + morbid obesity (n=1)

f. prohibition to bear weight on the injured leg + a social problem which does not enable patient discharge at the determined time (n=1)

g. advanced age + lack of justification for hospitalization (n=1)

2. Unwillingness of the department director to admit the patient to the rehabilitation outpatient clinic (n=2 ), due to:

a. residency outside the area that the clinic serves (n=1)

b. inappropriate behavior of the patient towards the doctor (n=1)

3. Other reasons (n=4) for example:

a. lack of available bed in the department (n=1)

b. discharge of a patient from the department as a patient in need of nursing care against the family’s wishes (n=1)

d. request made by the department director to leave the patient’s room during doctor’s rounds (n=1).

When lodging a complaint with the Department for Customer Relations at the medical center, people filing complaints may often write offensive remarks about the department director, for example: “reminiscent of the dark periods in history”, “level of garbage coming out of his mouth”, “request to summon the man to a hearing and to even dismiss him”, “waved me off with contempt”, “without human relations”, “a man exhibiting inhuman behavior”, “demeanor is found lacking”. Other expressions written dealt with decision making or the professional ability of the Director of the Rehabilitation Department detailed as follows: “it is not possible that a doctor can take the law into his own hands”, “since the woman became completely in need of nursing care, continued treatment requires hospitalization in the Dept. of Rehabilitation”, “unprofessional”.

In order to reduce friction between the Director of the Department of Rehabilitation, who makes the decision, and the patient and his family, other professionals may be recruited in order to assist. Referral to another specialist in the field of rehabilitation or geriatrics (for the elderly patient) in order to provide an additional opinion and the performance of function assessment by a professional in the paramedical field, that is, physiotherapist, occupational therapist or speech therapist, according to the existing illness or injury, may aid in coming to a final decision on the matter. Keeping precise records of the test findings and the reasons for non-admittance of the patient for rehabilitation treatment, as well as use of the “Ofek” computer program which stores patients’ medical information may carry considerable weight against the complaint filed.

In summary, complaints made by the patients and their families should be taken seriously even if they are unjustified and a precise written explanation why the patient is unsuitable for rehabilitation should be given. In addition, the director should not fear threats and pressure exerted by the family and other close associates while making a professional decision. Also, it is recommended not to confront the family face to face, where a discussion may turn into verbal violence and damage the good name of the department.

References

1. Hart J, Weingarten MA. A procedure for handling complaints against general practitioners. Family practice. 1986; 3: 107-112.
2. Mc Cleave SH. How to respond to a formal patient complaint. Seminars in medical practice. 2001; 4: 17-28.