How to prevent complaints and strengthen doctor-patient relationship

Communication sits at the heart of every meaningful relationship – between partners, families, friends, and equally between doctors and patients. When communication falters, relationships weaken. In healthcare, this breakdown can have profound consequences, contributing not only to dissatisfaction but also to formal complaints and even litigation. Understanding how communication fails, and how to strengthen it, is essential for safe, compassionate, and defensible medical practice. 

Why communication matters 

Effective communication is one of the most powerful tools clinicians have to prevent complaints and claims. It shapes our interactions with patients, guides our teamwork with colleagues, and becomes especially critical when things go wrong. Good documentation – our written communication – is equally vital, forming the backbone of any medicolegal defence. 

Research consistently shows that most claims are not driven by clinical negligence. In fact, 70–80% of litigation arises from poor communication between doctors and patients.¹ This means that even when care is clinically sound, communication failures can still lead to legal action. 

Why do patients sue? Predisposing and precipitating factors 

A helpful way to understand litigation risk is to consider the interplay between predisposing and precipitating factors. 

Imagine dropping a lit match on the floor. Usually, it burns out harmlessly. But if the floor is soaked in gasoline, the same match produces a very different outcome. The gasoline represents predisposing factors – conditions that make a patient more likely to sue. The lit match represents precipitating factors – the event that triggers the complaint. 

Predisposing factors include: 

- Rudeness 

- Delays 

- Inattentiveness 

- Miscommunication 

- Apathy 

- No communication 

Precipitating factors include: 

- Adverse outcomes 

- Iatrogenic injuries 

- Failure to provide adequate care 

- Mistakes 

- Incorrect care 

- System errors 

When poor communication and negative experiences accumulate, even a minor adverse event can ignite a major complaint. 

What effective communication really involves 

Communication is the exchange of thoughts, messages, or information through speech, signals, writing, or behaviour. But effectiveness depends on more than words alone. Research suggests that communication impact is distributed as follows: 

• Words – 5% 

• Tone of voice – 38% 

• Body language – 55% 

To convey a message clearly and compassionately, all three elements must align, especially body language. 

Words: Listening and understanding 

What we say matters, but how we listen matters even more. Patients need language they can understand, and clinicians must check that understanding is mutual. Communication should be an exchange, not a monologue. 

Studies show: 

• Patients typically need just 90 seconds to express their concerns. 

• Doctors interrupt after an average of 18 seconds. 

Interrupting too early prevents patients from sharing their full story and can damage trust. Allowing patients the space to speak is one of the simplest ways to strengthen the therapeutic relationship. 

Body language: The silent communicator 

Non-verbal cues often speak louder than words. Key elements include: 

• Appearance and facial expressions – A welcoming smile or a sincere expression when delivering bad news sets the tone. 

• Posture and alertness – Being attentive signals respect and interest. 

• Gestures – Inviting a patient to sit, avoiding distracting habits like pen-clicking or chewing gum. 

• Physical contact – You should be cautious with this. It must be appropriate, and always with awareness of personal, cultural, or religious boundaries. 

Patients often judge sincerity and empathy through what they see rather than what they hear. 

Documentation: Your written defence 

If records are absent or inadequate, defending a claim becomes nearly impossible. Good documentation allows clinicians to reconstruct a consultation without relying on memory. 

Key principles: 

• Use only universally accepted abbreviations 

• Avoid subjective statements. Stick to objective and factual information 

Clear, accurate notes protect both patients and clinicians. 

Communication with colleagues 

Professional respect within teams is essential – not only for morale but also for medicolegal safety. Up to 50% of litigation is initiated at the suggestion of another healthcare professional. A striking example is one of the largest payouts seen by Medical Protection in the Caribbean was triggered by comments made by one clinician about another. 

To maintain a safe and supportive team environment: 

• Keep colleagues informed 

• Involve the whole team 

• Show respect across all roles and levels 

• Offer constructive criticism when needed 

• Share positive feedback – small affirmations can have a big impact 

What we say about colleagues, and how we say it, can have far-reaching consequences. 

Communicating when things go wrong 

When adverse events occur, communication becomes even more critical. A structured approach helps prevent escalation: 

• Meet with the patient or family early 

• Acknowledge that something has gone wrong 

• Demonstrate that you understand their perspective 

• Remember: the patient’s perception is their reality 

• Explain what happened 

• Offer an apology when appropriate – courteously and professionally. It shows empathy, acknowledges the patient’s experience, and signals a commitment to improvement. 

You can contact Medical Protection if you have any concerns or need advice on this. 

What patients want when they complain 

Most patients who complain are not seeking revenge – they want reassurance and accountability. Common motivations include: 

- Preventing similar incidents 

- Receiving an explanation 

- Obtaining an apology 

- Ensuring accountability from the clinician or institution 

- Seeking financial compensation 

Understanding these motivations helps clinicians respond constructively and compassionately. 

Summary 

Effective communication is not an optional skill in medicine – it is a core component of safe, ethical, and defensible practice. From listening attentively to documenting accurately, from respecting colleagues to responding openly when things go wrong, communication shapes every aspect of patient care. When done well, it strengthens relationships, reduces complaints, and ultimately enhances the quality of care. 

References 

1 Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med. 1994 Jun 27;154(12):1365-70. PMID: 8002688.