Document Type: RESEARCH PAPER

Authors

1 Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA

2 Dell Medical School, University of Texas, Austin, TX, USA

Abstract

Background:
Patient concerns represent opportunities for improvement in orthopaedic care. This
study’s objective
is to identify the nature and prevalence of unsolicited patient complaints regarding orthopaedic care at
a tertiary referral hospital. The primary null hypothesis that there are no demographic factors associated
with complaint types was tested. Secondarily we determined if the overall complaint number and types
differed
by year.
Methods:
Complaints to the hospital ombudsperson by orthopaedic patients between January 1997 and June 2013 were
reviewed. All 1118 complaints were categorized: access and availability, humaneness and disrespect, communication,
expectations of care and treatment, distrust, billing and research.
Results:
Patients between 40 and 60 years of age filed the most complaints in all categories except distrust
(more common in patients over age 80) and research. Women were slightly more likely to address access and
availability, humaneness, disrespect, and billing compared to men. The overall number of complaints peaked
in 1999. The most common issue was access and availability followed by communication, and humaneness/
disrespect.
Conclusion:
Half of concerns voiced by patients addressed interpersonal issues. The largest category was related to
access and availability. Quality improvement efforts can address technology to improve access and availability as well
as empathy and communication strategies.

Keywords

Main Subjects

1. Hickson GB, Entman SS. Physician practice behavior
and litigation risk: evidence and opportunity. Clin
Obstet Gynecol. 2008; 51(4):688-99.
2. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-
Jaeger J, Bost P. Patient complaints and malpractice
risk. JAMA. 2002; 287(22):2951-7.
3. Caplan RA, Ward RJ, Posner K, Cheney FW. Unexpected
cardiac arrest during spinal anesthesia: a closed claims 

analysis of predisposing factors. Anesthesiology.
1988; 68(1):5-11.

4. Pichert JW, Federspiel CF, Hickson GB, Miller CS,
Gauld-Jaeger, Gray CL. Identifying medical center units
with disproportionate shares of patient complaints. Jt
Comm J Qual Improv. 1999; 25(6):288-99.
5. Schwartz LR, Overton DT. Emergency department
complaints: a one-year analysis. Ann Emerg Med.
1987; 16(8):857-61.
6. Taylor DM, Wolfe RS, Cameron PA. Analysis of
complaints lodged by patients attending Victorian
hospitals, 1997-2001. Med J Aust. 2004; 181(1):31-5.
7. Wofford MM, Wofford JL, Bothra J, Kendrick SB, Smith
A, Lichstein PR. Patient complaints about physician
behaviors: a qualitative study. Acad Med. 2004;
79(2):134-8.
8. Rosemont IL. American academy of orthopedic
surgeons, 1999 public image investigation. Second
report. New York: American Academy of Orthopedic
Surgeons; 1999.
9. Frymoyer JW, Frymoyer NP. Physician-patient
communication: a lost art? J Am Acad Orthop Surg.
2002; 10(2):95-105.
10. Tongue JR, Epps HR, Forese LL. Communication skills
for patient centered care. J Bone Joint Surg Am. 2005;
87(3):652–8.
11. Hickson GB, Pichert JW, Federspiel CF, Clayton EW.
Development of an early identification and response
model of malpractice prevention. Law Contemp Prob.
1997; 60(1):7-29.
12. Stata Corp LP. Stata Statistical Software Release 13.
Statacop, TX: College Station; 2013.
13. Sitzia H, Wood N. Patient satisfaction: a review of issues
and concepts. Soc Sci Med. 1997; 45(12):1929-43.
14. Williams B. Patient satisfaction: a valid concept? Soc
Sci Med. 1994; 38(4):509-16.
15. Delgado A, Lopez-Fernandez LA, Luna JD. Influence
of the doctor’s gender in the satisfaction of the users.
Med Care. 1993; 31(9):795-800.
16. Doering E. Factors influencing inpatient satisfaction
with care. QRB Qual Rev Bull. 1983; 9(10):291-9.
17. Hall JA, Dornan MC. Patient sociodemographic
characteristics as predictors of satisfaction with
medical care: a meta-analysis. Soc Sci Med. 1990;
30(7):811-8.
18. Khayat K, Salter B. Patient satisfaction surveys as a
market research tool for general practices. Br J Gen
Pract. 1994; 44(382):215-9.
19. Barrack RL, Ruh EL, Chen J, Lombardi AV Jr, Berend
KR, Parvizi J, et al. Impact of socioeconomic factors on
outcome of total knee arthroplasty. Clin Orthop Relat
Res. 2014; 472(1):86-97.
20. Elderkin-Thompson V, Silver R, Waitzkin H. Narratives of
somatizing and non somatizing in patients in a primary
care setting. J Health Psychol. 1998; 3(3):407-28.
21. Blanchard CG, Labrecque MS, Ruckdeschel JC,
Blanchard EB. Physician behaviors, patient
perceptions, and patient characteristics as predictors
of satisfaction of hospitalized adult cancer patients.
Cancer. 1990; 65(1):186-92.
22. Houts PS, Yasko JM, Kahn SB, Schelzel GW, Marconi
KM. Unmet psychological, social, and economic needs
of persons with cancer in Pennsylvania. Cancer. 1986;
58(10):2355-61.
23. Zahr LK, William SG, el-Hadad A. Patient satisfaction
with nursing care in Alexandria, Egypt. Int J Nurs
Stud. 1991; 28(4):337-42.
24. Cartwright A, Anderson R. General practice revisited:
a second study of patients and their doctors. London:
Tavistock; 1981.
25. Pascoe GC. Patient satisfaction in primary health care:
a literature review and analysis. Eval Program Plann.
1983; 6(3-4):185-210.
26. Weng HC, Steed JF, Yu SW, Liu YT, Hsu CC, Yu TH, et
al. The effect of surgeon empathy and emotional
intelligence on patient satisfaction. Adv Health Sci
Educ Theory Pract. 2011; 16(5):591-600.
27. Ha JF, Longnecker N. Doctor-patient communication:
a review. Ochsner J. 2010; 10(1):38-43.
28. Hall JA, Roter DL, Rand CS. Communication of affect
between patient and physician. J Health Soc Behav.
1981; 22(1):18–30.
29. Harmon G, Lefante J, Krousel-Wood M. Overcoming
barriers: the role of providers in improving patient
adherence to antihypertensive medications. Curr
Opin Cardiol. 2006; 21(4):310–5.
30. Herndon JH, Pollick KJ. Continuing concerns, new
challenges, and next steps in physician-patient
communication. J Bone Joint Surg Am. 2002;
84(2):309–15.
31. Mancuso CA, Sculco TP, Wickiewicz TL, Jones EC, Robbins
L, Warren RF, et al. Patients’ expectations of knee surgery.
J Bone Joint Surg Am. 2001; 83(7):1005-12.
32. Yoo JH, Chang CB, Kang YG, Kim SJ, Seong SC, Kim
TK. Patient expectations of total knee replacement
and their association with sociodemographic factors
and functional status. J Bone Joint Surg Br. 2011;
93(3):337-44.
33. Nilsdotter AK, Toksvig-Larsen S, Roos EM. Knee
arthroplasty: are patient’s expectations fulfilled? A
prospective study of pain and function in 102 patients
with 5 year follow-up. Acta Orthop. 2009; 80(1):55-61.

34. Bourne RB, Chesworth BM, Davis AM, Mahomed
NN, Charon KD. Patient satisfaction after total knee
arthroplasty: who is satisfied and who is not? Clin
Orthop Relat Res. 2010; 468(1):57-63.
35. Husain A, Lee GC. Establishing realistic patient
expectations following a total knee arthroplasty. J Am
Acad Orthop Surg. 2015; 23(12):707-13.