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Poor professionalism identified through investigation of unsolicited healthcare complaints
  1. Walther N K A van Mook1,2,3,
  2. Simone L Gorter4,
  3. Wendy Kieboom5,
  4. Miem G T H Castermans6,
  5. Jeantine de Feijter3,
  6. Willem S de Grave7,
  7. Jan Harm Zwaveling1,7,
  8. Lambert W T Schuwirth3,
  9. Cees P M van der Vleuten3
  1. 1Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
  2. 2Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
  3. 3Department of Medical Education Research and Development, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
  4. 4Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, The Netherlands
  5. 5Committee for Patient Complaints, Maastricht University Medical Centre, The Netherlands
  6. 6Department of Patient Affairs, Maastricht University Medical Centre, The Netherlands
  7. 7Maxima Medical Centre, Veldhoven, The Netherlands
  1. Correspondence to Dr Walther N K A van Mook, Departments of Intensive Care and Internal Medicine Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands; w.van.mook{at}


Aim To determine whether analysis of unsolicited healthcare complaints specifically focusing on unprofessional behaviour can provide additional information from the patients' perspective.

Methods A qualitative study with content analysis of healthcare complaints and associated judgements using complaints filed from 2004 to 2009 at the complaints committee of a tertiary-referral centre. Subsequent comparison of the resulting categories of poor professionalism to categories perceived relevant by physicians in a previous study was performed.

Results 137 complaints (98%) yielded 46 different unprofessional behaviours grouped into 18 categories. The element ‘perceived medical complications and error’ occurred most commonly (n=77), followed by ‘having to wait for care’ and ‘insufficient or unclear clarification’ (n=52, n=48, respectively). The combined non-cognitive elements of professionalism (especially aspects of communication) were far more prominently discussed than cognitive issues (knowledge/skills) related to medical error. Most categories of professionalism elements were considered important by physicians but, nevertheless, were identified in patient complaints analysis. Some issues (eg, ‘altruism’, ‘appearance’, ‘keeping distance/respecting boundaries with patients’) were not perceived as problematic by patients and/or relatives, while mentioned by physicians. Conversely, eight categories of poor professionalism revealed from complaint analysis (eg, ‘having to wait for care’, ‘lack of continuity of care’ and ‘lack of shared decision making’) were not considered essential by physicians.

Conclusions The vast majority of unprofessional behaviour identified related to non-cognitive, professionalism aspects of care. Complaints pertaining to unsatisfactory communication were especially noticeable. Incongruence is noted between the physicians' and the patients' perception of actual care.

  • Professional behaviour
  • professionalism
  • qualitative
  • complaints
  • quality improvement
  • quality in healthcare
  • medical education training
  • adult intensive critical care

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  • Competing interests None.

  • Patient consent Detail has been removed from these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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