The Silent Patient – What you don’t know can hurt you

December 20, 2017

As the head of a hospital or hospital department you are probably not in the habit of waking up each morning thinking: “Wow, the sun is shining, the coffee is percolating, and I just can’t wait to see all the new patient complaints we’ll receive today!” Obviously, the fewer complaints coming your way, the greater the likelihood that your patients are happy or at least satisfied with your organization’s services. However, a lack of patient complaints is not always a good thing.

Patients don’t always complain or make their concerns known to healthcare providers unless they are prompted. There is even evidence that some patients or companions may be reluctant to complain out of fear of retribution.[1] [2] The “silent patient” type will rarely complain and may even put on a happy face saying “everything is fine.” Yet under the surface he or she may be upset at a certain situation or even brimming with anger over a perceived infraction on the part of your staff. “Silent patients” have the potential to generate some of the most damaging complaints as healthcare providers are given no opportunity to resolve the issue. A patient’s dissatisfaction can just fester and lead to negative comments to friends and family or a broadside on a social media site three months down the road: “Don’t ever use ABC Hospital, the nurses are terrible and don’t speak English. I had terrible pain and they just ignored me…”

Observe and proactively seek out dissatisfied patients (and companions)

Hospital staff should always be on the lookout for dissatisfied patients. Train employees (particularly those on the frontlines) how to spot patients who may be dissatisfied but who have not expressed a complaint and about the proper way to handle complaints. The best way to spot a silent complainer is to cordially ask specific questions: How was our food? Are you okay with the pain medication? Is there anything I can do to make your stay more pleasant? Eventually, even the most reticent patient will usually open up about a perceived issue.


Once you have observed a problem that seems to happen repeatedly, you must then get down to the root of why the problem is occurring in the first place. Are the pre-op exams taking longer than normal? Is the package price you have set for the procedure package unrealistic? Talk to patients, ask questions, and keep track of suggestions and comments gathered through surveys or testimonials. Many complaints are due to uncertainties or a lack of information…”nobody told me,” “I didn’t know.”

Dealing with complaints promptly at the point where they arise should be seen as a priority throughout the organization. The basic principles for managing patient complaints are the same regardless of whether a patient is local or a medical traveler. However, healthcare providers should be aware that the unique circumstances of the medical travel experience can sometimes exacerbate certain situations and lead to misunderstandings. For example:

  • International patients are in the midst of a new culture and unfamiliar language which can lead to misunderstandings or misperceptions.
  • They may be alone and without the support of family members
  • The entire medical travel process is new to them which causes stress due to the unknown

Therefore, healthcare providers should:

  • Communicate clearly and often so there are no opportunities for misunderstandings
  • Lead patients by the hand and assume they know nothing about the medical travel process
  • Be particularly sensitive medical traveler patient needs and expectations
  • Let them know you are there to support them at all times

Global Healthcare Accreditation (GHA) standards recommend that traveling patients have access to a patient advocate who is responsible for maintaining communication between the patient, in their chosen language, and their healthcare provider to ensure patient understanding of procedures. This will reduce the risk for misunderstandings and also ensure patients have a go-to person they can trust if they have any problems.

Take action

When you see the same problem popping up again and again, this is usually a clear sign that you do not have a process set up to deal with it. The obvious solution is to create a process to eliminate the problem. In some cases you may not need to set up a new process but, instead, simply change a single step in your standard process. Using the previous examples, this may mean bringing patients in for pre-operative exams at a different time, or reassessing the costs of your medical procedure package so that they are in accord with reality.

What are the benefits of successful complaint handling?

So, what’s the upside to successfully resolving patient complaints? There are many. The Guide to Complaint Handling in Healthcare Services[3] states:

  • Prompt and speedy resolution of complaints
  • Reduced costs (direct and indirect) involved with complaint handling
  • Better risk management, potentially limiting the number of complaints that may become formal legal claims
  • Promotion of better health care outcomes
  • Better quality assurance, by providing feedback on service delivery
  • More satisfied consumers

Healthcare providers should not fear patient complaints; on the contrary, organizations should look at patient complaints, or any other feedback, as an opportunity to improve their processes and services. After all, your customers are providing you with golden nuggets of information that you may have not been aware of, and that if left unchecked, could continue to negatively impact other patients and ultimately your hospital’s financial bottom line.

[1] Ann Clwyd MP, Professor Tricia Hart. A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture. 2013. Retrieved 12/16/17 .

[2] ‘Silent majority' of older people do not complain about substandard care. The Guardian. Retrieved 12/16/17.

[3] “The Guide to Complaint Handling in Healthcare Services.” Health Services Review Council 2005, Victoria, Australia. Retrieved at‎