How To Make A Complaint

  • If you feel as though a medical practitioner has behaved inappropriately towards you in any way, you have the right to make a formal complaint. There are many different reasons you may feel uncomfortable about the care your doctor has provided and you should never feel as though your concern is too minor to be addressed. Anything that makes you feel uneasy is valid and needs to be addressed.

What are the reasons to make a complaint about my healthcare provider?

  • Your doctor has not provided a satisfactory level of care
  • Your doctor has not treated you with the respect or dignity you deserve
  • Your doctor has breached your privacy and confidentiality
  • Your doctor has not respected your autonomy
  • Your doctor has behaved unprofessionally

What are the kinds of things that warrant a complaint about my healthcare provider?

  • Poor communication skills
  • Dismissive approach to patient
  • Not validating a patient’s health concerns
  • Prescribing excessive amounts, inadequate amounts, or the wrong type or dose of medication
  • Touching a patient without first gaining their consent
  • Touching a patient in any way that could be perceived as inappropriate
  • Inadequate explanation of any element of a patient’s healthcare
  • Any kind of verbal or physical abuse
  • Disallowing a patient from being an active participant in their own healthcare
  • Being dishonest by either withholding important information from a patient or simply telling the patient information that is not true
  • Not disclosing possible conflicts of interest
  • Overcharging a patient
  • Practising medicine whilst being physically or mentally impaired

What do I do if I feel my healthcare provider has behaved inappropriately?

  • Talk to a trusted person in your life
    • This may be a family member or close friend. By sharing your concerns with someone you trust, it can help to not only make you feel better about the situation but also to feel as though your concerns have been validated before you go on to take further steps. The trusted person may be able to not only comfort you but also give you their own advice about how to best handle the situation.
  • Raise your concerns with your doctor or healthcare service
    • If you feel comfortable, you can talk to your doctor directly about their behaviour and how it made you feel. If you do not feel comfortable to do this, you can instead raise your issue to the receptionist or another healthcare worker, such as a nurse practitioner, where your doctor works.
  • Make a formal complaint through the main health complaints organisation in your state or territory
    • All states and territories have organisations that work to handle medical care complaints, with most being a Health Complaints Commissioner (HCC). All these services function in similar ways no matter the state or territory in which you receive healthcare.
    • All HCCs in Australia require patients to talk directly their healthcare provider before lodging a formal complaint, but the HCC can help you to do this and give advice if you do not feel confident.
    • The main role of HCCs is to help to settle disputes between an individual patients and/or their families and a specific healthcare provider, rather than focusing on the safety and welfare on the public more generally.

How do I make a formal complaint about my healthcare provider?

  • Each state and territory may differ slightly in the way in which they approach healthcare complaints. However, all jurisdictions do require patients to have first attempted to breach the matter with the healthcare provider before lodging a formal complaint. The way in which a complaint range from completing an online form, a hardcopy form and sending in the post, sending an email or calling the health complaints organisation.
  • Below are the links to each jurisdiction’s health complaints organisation website for more information about how to lodge a formal complaint.

What is the difference between AHPRA and a health complaints organisation?

  • AHPRA stands for the Australian Health Practitioner Regulation Agency. AHPRA works with 15 National Boards in Australia and is responsible for protecting the public by regulating all health practitioners registered to practice within Australia. It is AHPRA‘s role to ensures that all medical practitioners have the required training and qualifications, and practice in an ethical manner.
  • A health complaints organisation, sometimes also known as a health complaints entity (HCE) are responsible for managing problems that arise between an individual patient and their healthcare provider.
  • Therefore, the main difference between AHPRA and an HCE comes down to the fact that AHPRA can only investigate concerns where the safety of the public is at risk, whilst an HCE manages and handles concerns at a more individual level.
  • With this being said, AHPRA does work alongside an HCE and both may be involved in certain problems within the healthcare system, depending on the specific concern that has been raised by a patient.
  • AHPRA’s website provides a link to a brochure for each state and territory regarding how to make a formal complaint about a health, disability, aged care or community service provider. The brochure’s also help educate patients on the different roles of AHPRA and health complaint entities. Click here to view either a PDF or Word Document version of each jurisdiction’s brochure. An extract of Victoria’s brochure is shown below as an example.
  • Click here for more information about how AHPRA and HCE’s work together

What should I include in my written complaint?

  • A detailed description of the problem
    • What exactly has happened?
    • Why do you see it as a problem?
    • How has it made you feel?
    • What impact has it had on you and/or your family?
    • When did the problem start?
    • Has the problem been getting worse with time?
  • Any supporting documents that provide evidence of the problem
    • Written documents (letters, emails, text messages, medical records)
    • Images (photos of the service, medical images, medical scans)
    • Receipts and/or invoices
  • The way in which you would like the problem to be resolved
    • An apology and/or explanation from the healthcare provider
    • A refund or credit for the service
    • Better access to services
    • Correction of health records
    • Change in policy and/or practice by the healthcare provider

What happens after I make a formal complaint?

  • The flowchart below outlines the general Health Complaints Commission process after a patient has made a formal complaint.
  • Firstly, the HCC will assess whether the lodged complaint is appropriate for their office or whether the complaint will be better handled by another office (such as AHPRA. In the latter case, the complaint will be referred to the suitable office.
  • If the HCC accepts the complaint that has been lodged, there are three possible outcomes: early resolution, formal resolution/ conciliation and investigation. See below for a detailed breakdown of each possible outcome.

Resolution

  • Complaints resolutions are divided into two main types: early resolution and formal resolution.
  • As the patient, it is expected that you are respectful of all parties, actively participate, consider other’s viewpoints and alternate options and, in some cases, be willing to compromise.
  • In this process, the HCC is also respectful of all parties involved and is available for you at all times to ask questions, discuss matters and provide you with regular updates. It is the HCC’s role to be the impartial party that provides possible solutions, compromises and different outlooks on the matter.

Early resolution

  • An early resolution is most often the outcome of simple matters. In these cases, the patient’s complaint can usually be resolved quickly through a couple of informal phone calls and/or emails mediated by the HCC between the two parties involved.

Formal resolution

  • For more complex matters, the resolution process may need to be escalated to more formal actions and a formal resolution takes place. This may involve organising a meeting between the patient and healthcare provider, asking for written explanations, obtaining medical records, and/ or seeking medical expert opinions.
  • The HCC helps you to write a formal description of your complaint and proposes options to resolve the issue and proposes terms of agreement.
  • The description and proposed resolution are then sent to the healthcare provider. If the healthcare provider agrees to the proposed resolution, the agreement is documented in writing and shared with all parties. In the future, the HCC can check whether the provider has followed through on the resolution.

Conciliation

  • Conciliations refers to a number of documented steps that are agreed upon by all involved parties and carried out with the aim of achieving a formal resolution.
  • In a conciliation, all discussions are deemed completely confidential and privileged to increase honesty and openness in the process. It is an alternative to going down the pathway of legal proceedings which involves a hearing in a court of law. This means that neither party needs a lawyer, but are allowed to access legal advice at any time at their own cost.

Investigation

  • The HCC is able to undertake an investigation into a healthcare provider at any time which involves a detailed and thorough examination of their conduct.
  • The outcome of an investigation may be a temporary prohibition order of the healthcare provider’s services which may then transition to a permanent order if deemed necessary to protect the safety of patients.

Can I make a complaint on behalf of someone else?

  • Yes, you can lodge a complaint against a healthcare provider on behalf of somebody else. This is most often done by a parent, guardian, or carer*, but in some circumstances may also be done by another relative or close friend.
  • *A carer defined as a person who provides ongoing care or assistance with everyday tasks to a person who cannot independently carry out these tasks due to living with a disability or chronic illness.
  • To lodge a complaint on behalf of someone else, the health complaints organisation often requires that you declare that you have no vested interests in the matter, such as a financial interest.