Angry Doctor

Thursday, January 19, 2006

Anatomy of a Complaint Letter

I like reading complaint letters.

For two reasons:

First of all, I believe in the complaint letter as an avenue of feedback to let us know how we are doing.

It is also interesting to try to discern the intention behind the complaint letter, and how the writers had tried to craft the letter in such a way to make their complaints seem more justified, and the crime of the person/institution complained against more heinous.

Take for instance this one from today’s ST Forum. Bear in mind, as usual, that the letter may have been edited.

Why is KK Hospital keeping my son's x-ray films?

My seven-year-old son accidentally swallowed a paper clip recently. He was rushed to KK Children's Hospital where we were told to get an X-ray.

‘where we were told to get an X-ray’ instead of ‘where an X-ray was done for him’. Note the subtle difference?

To add to my anxiety, the radiologist proceeded with the request form routinely as she hummed to a song and teased my son 'you Superman ah?'

She showed no sympathy and was certainly oblivious to our distress. She also did not ask whether I required a copy of the X-rays.

Now, if you were the radiologist (who I assume was really the radiographer), how would you try to put the child at ease? Behave in a similar state of anxiety as the patient or his mother? In a quiet, clinical manner which might be interpreted as ‘uncaring’? Or try to be friendly and joke with the child?

An emergency procedure removed the paper clip lodged in my child's esophagus.

When the discharge summary came, it not only wrongly stated my son's gender as 'female patient' thus making my insurance claim more tedious,

It is customary when writing a complaint letter, it seems, to pad the primary complaint with other minor inconveniences experienced, which in this case would have been easily remedied by the clerical staff. And the primary complaint is?

... the hospital also refused to give the X-rays to me.

Right there.

Instead, it said that I did not make known my intention to the radiologist to have a copy before the X-ray was done. Isn't it the responsibility of the hospital staff or the radiologist to explain beforehand the policies and procedures to the patient before the X-ray was taken?

Actually, it doesn’t really matter whether her request for a copy of the X-ray was made known before or after the X-ray was taken, since one can always print extra copies, like with photographs.

It is the duty of the radiographer to explain the procedure before taking the X-ray; but to explain the policies? When she was already in a state of ‘distress’? What would she have said about the radiographer who was taking her time explaining the policy for requesting a copy of the X-ray film when her son was suffering from a medical emergency?

Still, her not having asked for a copy earlier on is no reason for not giving her a copy when she asked for it later...

Why is the hospital retaining the X-rays for non-chronic cases, which are eventually discarded, instead of scanning them into its system for future referral? Aren't we entitled to our own medical records and diagnosis?

I need the X-rays to remind and educate my children as well as for their personal medical record.

I think by the time a child is old enough to read an X-ray, he or she would not be swallowing paper clips. I know I stopped swallowing paper clips when I entered medical school – they were just too expensive at the CO-OP.

But seriously, this isn’t the first complaint letter concerning the release of X-ray films; there were a couple just these past couple of weeks? If memory serves, the hospital should be storing their X-rays electronically by now. Nevertheless, the process of obtaining a duplicate copy of an X-ray would still entail some signing of forms, and I suspect a payment, which was not mentioned in the letter.

I think the writer has a legitimate complaint (they almost always do), but again I take exception to the fact that she had chosen to implicate a healthcare worker (the radiographer/radiologist), who seem to have done her job safely and effectively, when her primary dissatisfaction was with the policy on release of X-rays.

It is no easy task to get a child to lie still enough for an X-ray, and it seems that despite the humming and 'superman' joke, the radiographer nevertheless managed to get a film done so that the child could have his emergency scope.

Equally interesting, of course, are the replies to complaint letters. Let’s see how the hospital reply to this one.



  • The boy is 7yo. Should be old enough to understand instructions. should be freaked out by the cold room with weird machines, to follow every word the radiographer says... holding his breath until face turns blue.

    In pte hosp (or at least the one i visited), they automatically give the x-rays to the patient leh. I got 1 whole stack of x-ray films @ home... dunno what to do with it.
    And they also give me a copy of all my blood test results. Thot i gotta start a new hobby collecting blood test reports when the concerned dr kept instructing for blood test to confirm that it's not dengue. :P

    The radiographer would only ask and make you sign the form to declare that u are not pregnant... got other procedures to explain meh??

    By Anonymous Anonymous, At January 19, 2006 6:40 pm  

  • I got a Qn on the policy of A&E dept.. is it a standard policy:
    Edlerly Grandma has been ill and sent to A&E. The whole clan rushed down to the hosp just in case it's the last chance to see her.
    While waiting for ER Drs to check on her condition, all of us were hanging out in the waiting area of the A&E which was pretty EMPTY.
    While I was trying to call my grandma's Cardiologist on the phone, this admin girl was gesturing to me to read a SIGN on the wall that "only ONE visitor for Each A&E Patient". And insisted that we should leave the A&E area. Asked her sarcastically that i hafta wait outside which is where the Ambulance is parked?? She nodded.

    ... don't understand the logic... we are not allowed to wait in the almost empty waiting area where are are so many seats, but it's OK for us to wait outside where the ambulance is zipping in with patients???

    Yes, we understand that A&E can be quite pretty busy and things may get CRAZY at times.. hence the "rule"... but on a quiet night, you can be flexible, right? *Bleah*

    By Anonymous Anonymous, At January 19, 2006 6:55 pm  

  • Is it not the squeaky wheel, that gets the grease ?
    Sad, but true...

    By Blogger Dr Dork, At January 19, 2006 7:39 pm  

  • It's probably different in a private hospital where it is understood that you pay for everything, even down the the last cotton bud. I guess in a public hospital like KK, they don't routinely provide copies of Xrays unless you are willing to pay for them.

    By Blogger tscd, At January 20, 2006 2:46 am  

  • "Yes, we understand that A&E can be quite pretty busy and things may get CRAZY at times.. hence the "rule"... but on a quiet night, you can be flexible, right? *Bleah* "

    I emphatize with you. However we must remember a few things. The A&E is a place where very sick people go to. Some may be suffering from highly contagious diseases too. We won't know until we've diagnosed them. And they may be waiting in the same waiting area as the "well" relatives of other patients.

    The SARS outbreak showed us the possibilities. As one of the few who were in the departments that got his by SARS and was personally admitted to TTSH for suspected SARS, I'll tell you that it is not a situation I'd want to go through again; not sure if I would infect my family, not sure if I would die...

    Anyway I think it's fine if you understand all this and say "I'd take responsibility myself if the relatives do indeed get infected by some strange virus or bird flu because I think it's unlikely and the hospital will not be at fault, so just let us hang around ok?"

    But otherwise, it makes perfect logical sense for me to limit the number of relatives in the A&E waiting areas. Some flexibility should be shown to relatives of course when the night is quiet and the A&E empty, but nevertheless, how "empty" the A&E is is subjective. For all you know the only other patient in the waiting area is the "suspected bird flu case" that just touched down at Changi Airport 1 hour earlier.


    By Blogger Dr Oz bloke, At January 20, 2006 9:23 am  

  • What's all this talk about SARS, bird flu etc.

    You appear to be adding to the hysteria. By now, the general population already know that the whole thing has been blown out of all proportions. Some pharmas are already laughing all the way to the bank.

    And may I ask why the A&E area of private hospitals are more user friendly?

    "you Superman ah?". On a night like this, a remark like this while distracting to the youngster may be insensitive to the parents. Health care workers certainly lack EQ and their IQ and PQ is certainly not up there either. A better way to distract the youngster would be, "you Superman Ah?" "Don't worry, everthin's going to be fine, young man." the last for the benefit of the parents and to make the remark about Superman a whole lot more palatable.

    By Blogger uglybaldie, At January 20, 2006 10:25 am  

  • Yes, I'm sorry. I am a running dog.
    Very sorry.

    By Blogger Dr Oz bloke, At January 20, 2006 11:18 am  

  • OZ,

    You in one of your pendulum moods again?

    Shall I get the shrink for you. I know a really good one, not on a professional basis but he is my golf buddy.

    Or would you prefer our world class mad house, the IMH?

    By Blogger uglybaldie, At January 20, 2006 11:28 am  

  • No need. I am perfectly sane and lucid.

    I realize my mistakes and I will atone for them.

    Your humble servant


    By Blogger Dr Oz bloke, At January 20, 2006 11:47 am  

  • Suit yourself.

    But I still think you're on the edge and around the fringe.

    Tell you what. Buy a punching bag. Give it a few whacks like Rocky or my idol, Muhamad Ali everytime you feel you are like a mouse climbing up a wheel and getting no where.

    Muhamad Ali, the Greatest, Man.

    Dances Like a Butterfly and stings like a Bee. The greatest, forever!

    By Blogger uglybaldie, At January 20, 2006 11:57 am  

  • Hey goofy doc,

    What is the riddle?

    Can't you speak simple english. Here in Singapore, we are pretty dumb ok?

    By Blogger uglybaldie, At January 20, 2006 1:32 pm  

  • It's Dr Dork, thank you. ha ha

    Just kidding.

    It is a common saying, quintessentially that those who complain the loudest are often attended to more promptly, regardless of the relative merit of their complaint.

    By Blogger Dr Dork, At January 20, 2006 5:58 pm  

  • Uglybaldie, i hope u get cancer and die. Yours sincerely, someone who really wants u to shut up and die.

    By Anonymous Anonymous, At January 20, 2006 10:12 pm  

  • Tink the radiologist is trying to calm the worried patient down, but maybe a bad way. hehe

    i myself encounter some unhappiness with the nurses at the hospital too...

    arrghh.. forget it. haha

    By Anonymous Anonymous, At January 20, 2006 11:51 pm  

  • I've met such patients more often than I can recall. After having read their complaint letters I more often than not drop them into the paper shredder. After having done that, one thought always comes to mind and makes the rest of my day go easier:

    "Jesus, I'm glad I'm not married to her. At least, I can go home at 4 o'clock."

    By Anonymous Anonymous, At January 21, 2006 12:09 am  

  • Whenever I used to read complaint letters like this, my thoughts would go back to the few Thai construction workers I had the privilege to attend to. Very stoic, always smiling and always grateful to whatever treatment given, no matter the amount of pain involved. Made me feel shameful of complaining about lesser things.

    By Blogger andrew, At January 21, 2006 12:27 pm  

  • I work with kids. One of my students spilled something on his pants and proceeded to have a meltdown. Like screaming hysterically, runny nose, laying across the table.....When I rushed over in "emergency mode" and found out what had happened, I exclaimed loudly- Are you killed?- No, he assured me. I cleaned him up and was TEASING when I asked him again if he was sure he wasn't dead. He was starting to smile and when I asked him if he was sure I didn't have to take him out to the playground and bury him in the sand, he was laughing and teasing back. Unfortunately, a parent from another class heard this exchange, and apparently missed the hugs, pats on the back, and soothing that was ALSO going on, and reported me to the office because HE was disturbed. Now, this is what I would call exaggeration- which teaches a child humour and brevity and the importance of keeping things in perspective. At NO time would I have proceeded with teasing him had I thought he was uncomfortable and afraid. And, these are the kids who during our dinosaur unit all drew me being eaten by a dinosaur- while they bravely saved me. They have imagination and humour and a sense of fun that in a group of mainly boys is quite vivid. I don't think that I acted terribly. Thankfully I was not disciplined, but I do not like strange parents around any more.

    The parents in the class are the people who tell me that their children adore me- teasing and exaggeration and all. I am the lady who makes ambulance sounds when there is a playground oops.

    My point is policy and style are two different issues. Get over the style, as no-one is the same as another- and attack fiercely the policy. If someone is being rude or evil talk to them immediately, and don't hide behind a letter or an anonymous complaint.

    And realize that children are much more resilient than we give them credit for being.

    By Anonymous Anonymous, At January 21, 2006 1:23 pm  

  • It's just this mentality of wanting the best service/treatment while not recognising what truely is happening and that most medical staff are actually trying their best (even when post-call at 5pm) to help them or their relatives.

    Granted that feedback is necessary but i feel most will just clog up the system and bog down the staff as they have to "answer" to their actions.

    By Blogger minimana, At January 21, 2006 9:11 pm  

  • 'Front-line' workers almost invariably bear the brunt because even when a 'customer' is unhappy with a policy, the more natural reaction is to put a human face to it, and guess whose is the nearest around? :)

    Children are strange creatures... they think Roald Dahl stories are funny and not scary...

    By Blogger angry doc, At January 21, 2006 9:14 pm  

  • As much as I dislike getting them (and angry doc has received his far share of complaint letters) I think we should keep the system.

    To me, having to answer ten 'unwarranted' letters is worthwhile to catch the one 'warranted' letter that will help us improve.

    I try to put myself on the other side - if I have a genuine wish for the system to change, wouldn't I want a ready and easy system to make my thoughts known? A form, or an email address or a hotline with someone on the other end who will respond with minimal delay?

    What you need to do is to look at complaint letters un-emotionally and separate the various grouses tagged onto the primary complaint, and see if any wrong had indeed been committed. Not an easy task as the first reaction when complaint against is to lash back.

    By Blogger angry doc, At January 21, 2006 9:24 pm  

  • One problem that I have with the "system" is that the complaint letters are handled by administrators who may have no experience on the ground and no understanding of the day to day running systems of doctors and health care workers.

    These admininstrators usually view complaint letters as extra, unwanted work for them created by insensitive and poor performing doctors and health care workers. They would rather be sitting around waiting for complaints that never come because everything is just so perfect and good. No work with salary, what a dream come true. But then the complaint letter comes "Urgh why the doctor like that *shake head*"

    Very often the doctor or health care worker mentioned in the letter would be viewed negatively by the admin staff and negative feedback would be given to his/her superior and a black mark lodged in his report card.

    Put it this way, if you were HR and it was promotion exercise time, and there were 2 doctors who were equally performing as well except for one difference : one with 1 complaint letter that year and the other with no complaint letters at all that year. Well even if the complaint letter was "unwarranted" how would you rank the two?

    It goes to show that most doctors and adminstrators would simply want a ZERO complaint letter year than not. Trust me I'm sure what I've written above is more the reality than what you have suggested.

    By Blogger Dr Oz bloke, At January 22, 2006 12:28 am  

  • " Whenever I used to read complaint letters like this, my thoughts would go back to the few Thai construction workers I had the privilege to attend to. Very stoic, always smiling and always grateful to whatever treatment given, no matter the amount of pain involved. Made me feel shameful of complaining about lesser things."

    What naivete?

    So is the way Singaporeans view doctors circa 40 years ago.

    So is the way some Banana Republic African nations view doctors before and now.

    So is the way the people of Indonesia and Timor Leste view doctors before and now.

    So is the way some isolated and impoverished provinces in China view doctors before and now.

    Wake up to the new reality. Doctors are just nursing assistants of the Creator, whoever HE is. He says you go, you go. He says you stay, you stay.

    By Blogger uglybaldie, At January 22, 2006 9:15 am  

  • "As much as I dislike getting them (and angry doc has received his far share of complaint letters) I think we should keep the system."

    Way to go, doc.


    If I were the Hospital Administrator, every complaint about ANYONE will be thoroughly investigated. The negligent recalcitrant will be counselled. The rude quack will be sent to courses on "How to win Friends and Influence People", the really incorrigible incompetent nincompoop will be transferred to Changi Hilton to serve in the infirmary.

    By Blogger uglybaldie, At January 22, 2006 9:21 am  

  • Dr Oz Bloke,

    Typically, in a MNC, the HR does not decide who to promote during performance review time. It is the Line Mgr or Dept Head. HR's role is to ensure that everyone is treated fairly in the process. The Line Mgr has to be prepared with good justification on his recomendation, because he/she is the one who gives feedback to the individual, not HR.

    (I don't work in a hospital, so don't know the performance mgt system in a hospital setup.)

    By Anonymous Anonymous, At January 22, 2006 10:46 am  

  • Oh God, that's depressing. It would be funny, really, except that it is so similar to a string of complaints the NHS gets, particularly the hospitals. Mrs Crippen is a radiologist and particularly sympathises.

    Trouble is, in the UK ALL these complaints have to be formally investigated, replied to and so on, and the costs are enourmous.

    Is you system "free at the point of entry"?


    By Anonymous Anonymous, At January 22, 2006 5:45 pm  

  • John, you authoritarian paternalist - what's wrong with a little feedback? :)

    Let me reply in a long and rambling manner...

    Offhand I can think of 3 types of complaint against doctors:

    The first and the most serious one is one filed with the Medical Council.

    There is actually a system in place to protect doctors against frivolous complaints in that in this case the complainant has to file a statutory declaration before the Medical Council will investigate the case. These are for cases of misconduct, malpractice, and physical or mental 'unfitness' to practice. The committee that does the preliminary investigation is made up of 3 doctors and 1 layman.

    Then there is the internal system of the medical establishment, being feedback forms, hotlines, and emails. I suppose different organisations have different ways of handling these complaints, but I suspect their priority is to ensure that these do not escalate to a formal complaint to the Medical Council, or into a lawsuit. It is probably not profitable to tell a complainant his or her complaint is frivolous and would be dismissed.

    Then there is the open letter to the press. This is to me most 'damaging' as the audience has no other source of information on the complaint at the time of receiving the information, and there is no onus on the writer to substatiate his or her statements. I do not know if the press conduct their own investigation to verify the facts.

    We had a case a while back where a complainant got the dates and even the hospital involved wrong in the letter! No defamation suit was filed in response.

    In this case the organisation involved will need to write a reply to the press before the matter gets blown up (or blows over, in which case everyone will only remember the bad press and ignore the late reply).

    These reply letters have their own pattern or anatomy, which I hope to write on when the reply to our current complaint is published in a few days.

    Personally I think a published reply is also fraught with peril as it runs the risk of breaching patient confidentiality. Discussing the patient's diagnosis in what is essentially an open gossip forum is not a smart legal move, especially if some of the facts contained therein may later become material in a court of law.

    I suppose there is a cost to all this, although I do not know what it runs to. But as it stands I don't think I will root for the alternative of NOT having an avenue of complaint other than a court of law, or NOT having every complaint looked into and risk having a repeat systemic or human fault escape un-noticed until it blows up in our face (google 'Singapore NKF scandal' for a slightly related topic).

    Our system is one of co-payment for those who wish to enjoy government subsidies:

    Those who wish for free healthcare may apply for further assistance.

    By Blogger angry doc, At January 22, 2006 6:27 pm  

  • "Health care workers certainly lack EQ and their IQ and PQ is certainly not up there either."

    What exactly is this based on uglybaldie? I'm sorry if this seems to have been your experience so far, but it's an unjustified and offensive generalisation to apply this to all health care workers.

    By Anonymous Anonymous, At January 22, 2006 8:00 pm  

  • Dear anonymous from the HR department of an MNC,

    I've spoken to a couple of my classmates who are in various organizations, ranging from MNCs, to civil service, to stat boards to private firms etc

    Many of them are in positions to influence or dictate the career progression of staff in their organizations.

    They have frankly admitted that the decisions to promote staff are all based on very subjective opinions.

    One friend who worked in a very prominent governmental organization said that they did actually try once to rank all the eligibile staff according to points. However at the end of the exercise they all looked at the rankings and felt it wasn't right. The top person based on scores of performance, team work, punctuality etc etc was not what they "felt" the top performer. Hence the whole ranking was torn up and they just went on to discuss/vote/agree Person A number 1? Person B number 2? and so on.

    Personally I don't believe in HR. Life is all about human relationships and their developments. There is no such thing as equality.

    HR's job is actually to be there to say such things as "HR's role is to ensure that everyone is treated fairly in the process" to gullible staff who form the majority. This ensures that the truth can never be proven because there is "existence" of the HR department. But in truth and in practicality all the literature written in the HR books are merely guides and evidence to protect the image and facade.

    Of course as a member of the HR fraternity you would never admit what I have alleged is true or else you guys would lose your jobs.

    But I KNOW what I have written is true. Personally I had used this knowledge to my advantage far more than once during my time in the hospitals.

    By Blogger Dr Oz bloke, At January 23, 2006 10:12 am  

  • Interesting, anonymous from HR had nothing to say about my comments.

    'nuff said

    By Blogger Dr Oz bloke, At January 26, 2006 10:44 am  

  • On the contrary, prepared long essay regarding your comments. However, it's rude to hijack a medical blog to give you a lecture on HR. So, I kept quiet lorr. :)

    By Anonymous Anonymous, At January 26, 2006 2:52 pm  

  • Feel free to give me your lecture at my blog then. It is not a problem to me :)

    By Blogger Dr Oz bloke, At January 26, 2006 7:01 pm  

  • Argh!'s worst for alternative medicine as chiropractors aint even properly recognise in Sg and the hassle of loaning the xrays from hospitals are way worst!

    By Anonymous Anonymous, At February 01, 2006 4:50 pm  

  • Dangerous doctor: Hello Once I went to the country, Sri Lanka and I fell ill. I was recommended the following doctor Dr Lanka Wijesena of the Australian Medical Centre, 56/3 Horton Place. The doctor neither could figure out what I had no had the humility to accept her inability. She continued to give me more blood results without any avail. I consulted a different doctor who said that I was suffering from dengue and advised me to bed rest. My life could have been at risk due to her incompetency.

    By Anonymous Anonymous, At July 03, 2012 2:26 am  

  • I know site I stopped swallowing paper clips when I entered medical school – they were just too expensive at the CO-OP.

    By Anonymous Anonymous, At July 04, 2012 1:11 am  

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