Few patients enter our health care system prepared for the unexpected and embarrassing circumstances that can routinely happen.

Most can accept it when we’re treated with modesty and respect.  But not many are prepared for those times when you might be unnecessarily exposed or treated rudely.  The possibilities for embarrassment are endless and it is usually unexpected.   When avoidable incidents do happen, most patients are not prepared to speak up.  Many regret their inability to speak at the time of the incident.

In fact it is important to speak up at the time of occurrence if at all possible, or if not, as soon as possible thereafter.  It can often be difficult or impossible to identify the offenders days or weeks after the occurrence.  Situations are most likely to be rectified if they are brought to the immediate attention of the offenders and their superiors.   A common example would be being exposed in an examining room when someone leaves the door open or comes in without warning.  Few patients appreciate that but most don’t say anything.  But if you wait several days to complain, it is likely that the office will not remember who was involved.

Despite your embarrassment, the office personnel may recall nothing unusual; it was just in a day’s work for them and consideration of patient’s privacy doesn’t cross their radar.  In a hospital a common occurrence would be for the patient to be exposed during a bath or procedure with the curtain or door being left open.  The potential is even greater for embarrassment if you’re in a semiprivate room and your roommate has visitors.   Even without exposure, having your history taken in a semiprivate room with or without visitors present may cause you to reveal embarrassing and confidential information.  Once again, if you don’t speak up immediately, it will be difficult to identify the perpetrators later.

It helps to have a clear idea what you want from your protest.  A simple apology is the easiest to obtain and may be all that’s needed.   If you want a clear indication that policies will be changed to prevent re-occurrences of the problem, you will need to go beyond a simple apology and communicate the problem with the physicians or managers in charge.  They may indicate that policy directives will be updated and sent out on their own, but if not you may have to request that they take specific action to correct the problem.

The best course of action to take depends on where the incident occurred.  Usually make the complaint immediately to the person who caused it.  In an office, this could be the physician, nurse or assistant.  If you’re not immediately satisfied with the response, also bring your complaint to the physician in charge.  If the infraction was incidental, a simple apology should be enough.  If the infraction was part of a pattern of behavior, you should notify the physician in charge.

If you don’t complain at once, the next best course is to call or write a letter as soon as possible afterwords.   If the complaint is serious and you remain unsatisfied by the response, the usual next course of action is to lodge a complaint against the physician with the state medical board.  All 50 states have them.  If they don’t handle the complaint themselves, they will tell you where to take it.  All states have a board which investigates complaints against physicians.  In all cases, when a written or electronic complaint is filed, you should keep copies and note that you will send copies to their superiors , or to the state and federal institutions which may have jurisdiction.

In a hospital, again make your displeasure immediately known to the person responsible.   If not satisfied, take your complaint to the head nurse or physician in charge.   Try to get the names of the people involved so that you can pursue the complaint more profitably.  If the complaint is against a specific nurse, you can also complain to the state nursing board.  Again all 50 states have them and will investigate complaints.  Most hospitals will deal with complaints against specific personnel internally.  If this doesn’t work, continue up the hospital hierarchy.  Most hospitals have a patient advocate whose job it is to handle complaints.  Start with her, but remember that she still works for the hospital no matter her title.  If still no satisfaction, I would send a letter to the CEO of the hospital.  When formulating complaints against a hospital, it is well to remember that nearly all publish a patient bill of rights which might give you considerable help in outlining your complaint.  If still unsatisfied, you should consider sending a complaint to the state board that regulates and licenses hospitals (I haven’t found one website that lists them for all states.)

Another possibility is sending a complaint to JCAHO, the Joint Commission on Accreditation of Healthcare Organizations, usually now shortened to the Joint Commission.   They are more likely to respond to systemic complaints against a hospital rather than one incident unless there were life threatening implications to the occurrence.

Probably the last place to complain is with HIPAA.  They do take patient complaints but they are not oriented towards individual complaints unless it clearly has to do with information transfer.  If say a hospital posted photos of your operation on an instructional site without your permission, it could fall under their purview.  There is no right of private action under federal law though there may be under individual state laws.  Finally you can contact a lawyer at any time but beware that most privacy violations won’t bring large monetary damages.  So do so only if you are really motivated to obtain redress as the attorney bills will be significant.

Joel Sherman is a cardiologist who blogs at Medical Privacy, A Patient Oriented Discussion.

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