"The patients who really help you the most," a doctor says, "are the ones you don't get along with. "They're the ones who tell you there's something wrong with the way that you're practicing. One way they tell you is that they leave you. Or, what's really more helpful, they complain. So you learn."
Another physician, Dr. Norman Lee Barr, chairman of the grievance committee of the District of Columbia Medical Society, gives his fellow doctors plain-speaking reports on the complaints this group gets from dissatisfied patients.
The most common ones in Washington -- and in this area generally, other doctors say -- are:
* Fees, because they seem unjustified or too high or because an insurance plan has refused payment.
* Failure to send another doctor a patient's medical records.
* Waiting long periods of time for scheduled appointments.
* Rude or cavalier treatment, either by the physician or, more commonly, the office staff.
"A large number of the problems could have been avoided," Barr tells his colleagues, "with proper physician-patient communication."
There are, unfortunately, doctors who are habitually rude or hostile or so rushed or distant that they never seem to listen or care, acknowledged three doctors in recent interviews -- Barr, Robert Collins, 1985 president of the medical society, and John J. Lynch, 1984 president.
But, they said, all but a few doctors care about their patients and try to do a good job. Surveys of patients bear this out. Most of us indeed feel our own doctors care.
Still, we all have complaints sometimes.
Fees trigger the most gripes. The District doctors concede that some charges may be excessive. One health insuror tells of cases where a doctor charges from $115 to $320 for "excising a benign lesion" when the proper billing should be $34 for an acne treatment. Substantial complaints currently are forwarded to the District's Healing Arts Commission, which often asks the society to investigate.
Many doctors will adjust their fees when patients explain that they just can't pay so much. I know one senior citizen who has commonly told her doctors that she lives on her Social Security and a modest amount more and often can't afford the extra charges Medicare doesn't cover. She usually gets an adjustment.
Yet doctors and patients alike seem shy today about discussing fees, Collins says. "Before there was so much medical insurance," Lynch adds, "there was often such a dialogue. That seldom happens now."
Barr urges doctors and their staffs "to make common the uncommon practice of discussing fees . . . both before providing services and throughout treatment. Explain what is included . . . If a final bill is higher than the one quoted, include an explanation."
When a patient decides to see another doctor, the first physician is ethically obligated, if asked, to send a prompt report and pertinent records or summaries to the new doctor.
Yet the D.C. Society periodically hears from patients whose doctors have failed to forward their records. In one case, Barr says, "a physician refused to do so until his bill was paid in full. That's wrong. The new physician must have full information. The patient's interest comes first."
"Not all the complaints we get have merit," Barr says. He pointed to cases where patients wanted doctors to falsify treatment dates so they could collect health insurance, or where patients refused to pay a bill because another doctor thought the diagnosis or treatment was wrong. Sad to say, there is nothing about medicine -- still part-art, part-science -- that guarantees a cure. If a doctor spends time and energy doing what seems right, he or she is entitled to payment.
But what about the rude or seemingly incompetent doctor or staffer?
Complain. If possible, complain first to your doctor, who will probably be surprised and listen carefully.
If problems persist, write -- don't phone -- your local or county medical society. A written complaint is needed to provide a sound legal basis for inquiry. Be specific. What happened? When? Where? Give the society permission right at the outset to see your medical and hospital records.
"We really value these letters," Barr says. "When there is a real pattern of inappropriate behavior, we usually get more than one complaint. This tells us there's really something going on."
Does the doctor you complain about care?
In almost all cases very much so, says Collins. "The average physician does not want to be called before our committee and will do everything he can to work the matter out. When you're out there trying and think you're doing a good job, it really does something to your ego to hear that a patient thinks otherwise."
Next Week: Getting up the courage to complain to your doctor -- and other places to complain.