A patient walks into your office with a result that doesn't match their expectations. Maybe the pain persists, the aesthetics aren't what they imagined, or a complication arose despite correctly performed care. In that moment, the clinician stands on thin ice — and what you say and do in the first few minutes decides everything that follows.
01First reactionThe most important moment of the whole dispute
Most malpractice suits in healthcare don't arise because something went wrong. They arise because the patient felt no one explained what and why properly, or because the clinician acted defensive and cold. Research on medical-legal disputes consistently shows that open communication and early empathy dramatically reduce the likelihood of escalation.
The moment you realise the outcome doesn't match the plan — whether a complication, treatment failure or patient dissatisfaction — act immediately. Don't wait for the patient to arrive with a lawyer.
- Reach out to the patient actively. Call or invite them for a check-up the same day or the next morning.
- Don't open with defence. The first sentence must not be an explanation of why you did nothing wrong.
- Express regret without admitting fault. "I'm sorry you feel this way" or "I'm sorry the outcome isn't what we both wanted" — that is not an admission of error, it is a human approach.
02The conversation with the patientWhat to say and how to say it
A meeting with a dissatisfied patient has its own structure. Improvising is the biggest mistake — especially if the patient is upset or arrives with company.
Setting: Always in a private room, never at reception or in the waiting area. Sit down — a standing clinician looks like someone who wants to leave quickly.
Structure of the conversation:
- Listen without interruption. Let the patient say everything they want to say. Don't nod mechanically — look at them, take notes.
- Summarise what you heard. "If I understand correctly, what's bothering you most is that the pain persists and the outcome doesn't look the way we planned." That shows the patient you truly heard them.
- Explain the situation clearly. No jargon, no shortcuts. What happened, why it could have happened, what the options are going forward.
- Offer a concrete solution. A free follow-up consultation, retreatment, a referral to a specialist — whatever is realistic and ethical in the situation.
- Agree on a next step. Never end the conversation without a clear plan: "We'll see you in a week and check how it's developing."
Understanding the difference between an "I'm sorry" that expresses empathy and an "I'm sorry" that accepts responsibility is the foundation of every successful response to an adverse event.
Saxton & Finkelstein · Journal of Medical Practice Management, 2008
03DocumentationYour best defender
If a dispute does reach court — anywhere in the world — the medical record decides. Courts and expert witnesses don't ask for your memories. They ask for the record.
Immediately after the conversation with the patient, write into the record:
- Date and time of the conversation
- Who was present (patient, companion, assistant)
- What the patient said — in their own words, without interpretation
- What you explained — what information you provided
- What solution was offered and whether the patient agreed
- The plan going forward
Never record evaluations of the patient as "uncooperative" or "aggressive" — such words turn against you in a courtroom. Describe facts, not emotions.
04EscalationWhen the patient really threatens to sue
If the patient explicitly mentions a lawyer, compensation or court, the situation enters a new phase. It doesn't mean the dispute is inevitable — but it requires a different approach.
What to do immediately:
- Inform your insurer. Most professional liability policies require reporting a potential dispute as early as possible — not only after a claim is filed. This holds globally.
- Do not communicate with the patient without the insurer's knowledge. Every word from this point can be used as evidence.
- Do not alter the records. Any retroactive modification of records is a criminal offence in every jurisdiction. If information is missing from the record, you can add a dated note — never overwrite the originals.
- Seek legal counsel. Ideally a specialist in medical law in your country.
What not to do:
- Do not promise financial compensation without the insurer's consent
- Do not contact the patient repeatedly without a clear purpose
- Do not discuss the case with colleagues beyond what is strictly necessary — breaching confidentiality is a separate legal problem
05PreventionHow to prepare for these situations in advance
The best crisis management is the one that prevents the crisis. Three pillars that work in every country:
1. Informed consent as a dialogue, not a form. A signature on paper isn't enough. The patient must truly understand the risks, alternatives and realistic outcomes. Document that you explained it — verbally and in writing.
2. Realistic expectations from day one. Overly optimistic prognoses are one of the most frequent causes of disputes. Research from Danish dental complaint boards has shown that a large share of complaints stems from a mismatch between what the patient expected and what actually happened — not necessarily from technical error.
3. Open communication during complications. Patients who are kept informed throughout — even of bad news — file complaints far less often than those who feel something was hidden from them.
Handling a situation where treatment doesn't go to plan is one of the hardest things in clinical practice. It isn't just a question of law — it's a question of who you are as a clinician. Patients remember how they were treated far longer than what they were told.
Tým za platformou Cicero. Píšeme o digitalizaci ordinací, klinickém workflow a o tom, jak technologie mění každodenní praxi.