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What To Do If You Have Been Wronged By A Doctor


If you have been wronged by a doctor, you can forgive, even if you don't forget. If you don't want to forgive, and you want to do something, you can do any or all of the following,


  • If you are willing to forgive the incident, at least let the doctor know what happened.
  • Meet with the doctor to discuss what happened - preferably in a special appointment just for this purpose. (Also make sure neither you nor the insurance company gets billed for the appointment.)
  • This kind of communication can help preserve the relationship by taking resentment or anger out of it. At the same time, it will hopefully help the doctor understand that she did something wrong, and hopefully lead to the problem being corrected in the future both for you and other patients.
  • If you prefer not to meet with the doctor about the subject, write a letter. Explain in polite terms what the doctor did wrong, and how it affected you. (Before you draft the letter, see Complaint Letters, below.

Complain to the state licensing bureau.

  • If you feel that your doctor has practiced negligently or incompetently, or has engaged in illegal or unethical practices, report her to whatever group is in charge of investigating and making decisions about complaints against doctors. The group is likely to have a name like Office of Professional Medical Conduct or Medical Conduct Unit. You can locate the one in your state through your county or state medical association or through your State Medical Board (see Federation of State Licensing Boards list at offsite link.
  • You will likely be required to file your complaint in writing. The group can provide a form.
  • The group will investigate your claim. If it finds evidence of misconduct, charges will be filed against the doctor.
  • If sufficient evidence is not found, the case will be closed -- but the matter will remain in the doctor's file for future reference.
  • If evidence of misconduct is found, there will likely be a hearing. A decision will determine if a penalty is warranted. Penalties can range from a slap on the wrist, to a fine, to taking away the doctor's license to practice medicine.
  • The doctor will have the right to appeal. Unless there is an immediate threat to the public health, the process can take a long time.
  • Typical complaints include the following misconduct:
    • Working while drunk or on drugs.
    • Doing the wrong procedure or on the wrong part of the body.
    • Not providing immediate care when it is needed.
    • Refusing to provide care due to race, color, creed or ethnic origin.
    • Guaranteeing a cure.
    • Performing professional services which the patient didn't authorize.
    • Failing to make patient records available to the patient or another physician.
    • Breaching confidentiality.
    • Any sexual activity with a patient.
    • Fraudulent claims, including Medicaid or Medicare (which should also be reported to 800.MEDICARE).
  • Following are complaints which are not generally reason for disciplinary action by the state licensing agency:
    • Fees which you think are too high, unless there is fraud such as a charge for a test or service that was not provided.
    • Complaints about a doctor's communication skills, attitude or "bedside manner".
    • Office practice issues such as a long wait or a rude staff.

Complain to a medical society.

  • There are medical societies at the local (such as county), state and national levels.
  • National associations include the American Medical Society and associations for the various medical specialties. Check with each to see if your doctor is a member. You can check membership in the American Medical Association at offsite link, under "Doctor Finder."
  • After you file your complaint in writing (each organization generally has specific forms to use,) there will be an investigation, including a chance for the doctor to be heard.
  • A decision against the doctor will not affect her license to practice medicine. However, it can result in expulsion from the group, censure or other similar action.

Complain to a hospital.

  • If the action occurred in a hospital, a complaint to the hospital can result in the doctor losing the right to work at that hospital, or at least to remove the doctor from the hospital's referral list.
  • Contact the office of the head of the hospital. You're likely to speak with his or her assistant who can give you the name of the appropriate person to contact. That person will explain the hospital's procedure.

Complain to the doctor's partners.

  • If your doctor has partners, or is part of a group, contact the managing partner or doctor in charge of the group, preferably in writing. People tend to take complaints in writing more seriously than complaints on the phone.
  • Peer pressure may get the doctor to change behavior.
  • If the situation is bad enough, or there are enough complaints, the group will likely push the doctor out.

Complain to insurance companies.

  • A complaint to an insurance company with which a doctor is affiliated, or by whom a doctor is employed, can result in the doctor being pushed to change behavior, or possibly end the doctor's relationship with the company.
  • Contact the insurance company and ask for the contact information of the person who handles complaints against doctors. Submit your complaint in writing.
  • Expect that the company will contact you for more information. If the company doesn't respond, write a follow-up letter or call to find out what happened to your complaint.

Complain to the police.

  • If a law has been broken, such as practicing without a license, complain to the police.
  • Keep in mind that you may be subjected to publicity about the matter if the case goes to court. However, if the doctor's action is so bad that it violates criminal law, you will be helping prevent injury to other innocent patients.
  • If you are concerned about publicity, let the police know so they can work with you.

Seek monetary damages through a malpractice claim.

  • To obtain money for damage caused by a doctor, file a claim for medical malpractice or other action -- depending on what the doctor did or did not do.
  • This could either be in court, or in more informal settings such as mediation, arbitration or a neutral third-party case evaluation.
  • Medical malpractice is conduct that:
    • Fails to live up to the profession's standard of care toward a patient.
    • That results in physical or financial loss or damage.
  • Just because you have been wronged, or been injured, does not mean the doctor is liable to pay you money. Things happen which are not anyone's fault. To win a malpractice claim, you will have to prove four things:
    • The doctor had a duty to you. Duty to a patient requires the establishment of a provider-patient relationship.
    • You received substandard care. (The law imposes a higher duty on a specialist than on a general practitioner.
    • You have damages -- injury or harm that can be measured in monetary terms, and
    • That the substandard care resulted in those damages.
  • You will need to start your claim within a set period of time after the occurrence of the problem -- such as one year. The time limit varies from state to state and depends on the subject matter of the suit.
  • You will need a lawyer to help you pursue your case, preferably a lawyer who specializes in medical malpractice cases.
  • Generally lawyers in medical malpractice cases work on a contingency basis -- which means they only get paid for their time if you get paid. (They may get paid for their out-of-pocket expenses even if you lose.) While the exact percentage and arrangement will be spelled out in a contract with the lawyer, the percentage is usually about 25 to 33 percent of the final damage award. Many states regulate these fees.
  • You can pay the lawyer cash on an hourly or fee basis instead, no matter what the outcome. However, if you can't find a lawyer willing to work on a contingency basis, you have to ask yourself whether it is really worth pursuing the case in court either because you're not likely to win the case, or because the potential reward is limited.
  • If you have questions about picking a lawyer, see Choosing An Attorney.
  • Court: You may be required to go to a pretrial screen panel before going to court to review your case. More than 30 states have established these review plans. The panel (usually including at least one attorney and one physician) hears the case and makes a recommendation. The parties can accept the panel's decision, negotiate their own settlement, or reject the decision and go to court. There may be penalty provisions against the party that disregarded the panel decision and goes to court.
  • Informal dispute Resolution: Arbitration and mediation are private, non-government procedures between two parties. Both parties agree to submit their case to a person or panel to review the facts of the case and make a binding decision. Sometimes arbitration is required by group insurance plans or by signing an agreement with the doctor.

Which avenue to take depends on your goals. For instance:

  • Consider forgiveness if you have a strong attachment to the doctor that you want to keep, want to get on with your life, or feel too sick to pursue an action.
  • If you want to stop the doctor from continuing a certain behavior, complain to the state licensing bureau and/or a medical society to which the doctor belongs.
  • If you want to get the doctor into rehab for drug use, complain to the state licensing bureau and/or the doctor's partners or employer.
  • If you have become incapacitated by an awful error, you will likely want to seek monetary damages.

How to write a complaint letter.

  • Any complaint letter should be written with the goal of conveying the facts in summary form so that the person who receives the letter can understand the problem. Letters should not include emotion, or facts that are not relevant.
  • A complaint letter should include:
    • The full name and address of the doctor.
    • When and where the problem(s) occurred.
    • The names and contact information of people who have additional information about the situation. Attach statements from those people if possible.
    • Documentation such as a copy of the relevant section of your medical records, letters and bills.
    • What, if anything, had to be done to correct the situation.
    • Your damages.
    • All other relevant information.
  • A request that you be advised of the procedure the person or entity that receives the letter will follow.

Even if you are not pursuing legal action, it would be helpful to have your attorney review the complaint letter before sending it. Also, if you note in your letter that you are sending a copy to your attorney, you can be sure that the matter will be treated with utmost seriousness. This does not mean your complaint won't be treated seriously -- it just adds a bit of pressure.

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