CHOICE membership

Medical specialist - complaints process

Greetings all,

I saw a specialist (let’s call him “Dr X”) in 01.2021. He charged $460. I explained my symptoms and asked for them to be investigated. Dr X declined and instead began to Rx’d a benzodiazapine (tamezepan), which I declined. He then Rx’d a tricyclic antidepressant which he claimed works like a sleeping aid when taken in small doses. He handed me the Rx. I was not happy. He saw that and said 'well in that case, take the meds for 2 months and if you still have problems, we’ll investigate then".
“Sure” I thought. “You’ll fleece me for another $460 for a needless consult and who knows how much for the investigation which by that time would be late if my problems need solving now”.

His secretary made the follow up appointment for 2 months’ time.
When I got home I thought, “no way will this solve the problem as in 2 months’ time any investigation will analyse not my true state but by state on meds”. I cancelled the f/u appointment and went for a study elsewhere, with “Dr Y”. That meant I had to pay another specialist for an initial consult.

That study produced data that proved my allegation that I have significant health symptoms that need to be addressed.

Recently I sent “Dr X” a demand for a refund of the (circa $250) being the out of pocket costs based on the results of “Dr Y”'s test. I sent a copy to the hospital where he works.
Of course I should have demanded he replay Medicare as well for the misdiagnosis and inappropriate Rx’ing of meds.

The 10 days I gave him to pony up the refund came and went earlier this week.

What are my next steps?
Complaining to the NSW Health Care Complaints Commission or somewhere else?

Note I recall years ago a friend made a complaint to a hospital which was “resolved” by one doctor “reviewing” the behaviour of a colleague. No ribbons for concluding that complaint went nowhere.

All suggestions are welcome. Thanks.

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Reality is GPs and surgeons make calls on their own experience and training, and very unfortunately not always on the knowledge of their patients. Yet it is seen as a judgement call not malpractice more often than not.

The medical field protects its own and it is only when there are enough complaints lodged against a doctor, and often if it also hits the press, before anything is done.

You did well to walk from Dr X. Make a complaint,

expect nothing, and move on. Finding a good practitioner is gold in itself.

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I hear you. The problem in Oz is that most patients shy from complaining.
Recently I met a fellow who saw the same specialist 5 years ago and his malaise was not treated correctly. His illness remained and his bills mounted. His health was poor so he at time did not have the energy to complain.

Prior to this unfortutnate episode, I saw this same specialist (8 years ago) for a related illness and at that time he did investigate and put me on what are clearly the right meds. I think with age he has lost interest in his works. It was his investigation at that time that convinced me to see him again.

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As you stated he works at a Hospital, you can also make a complaint to the Hospital Management regarding the Specialist’s behaviour. You can also contact your State Health Department as Doctors still need to often register in the State/States they practice in, Federally you can contact the Medical Board of Australia as they also undertake performance reviews You can also lodge a complaint with the Specialist’s College of practice eg for a Psychiatrist this would be the RANZCP., Surgeons use RACS, Physician would be the RACP.

You could directly complain to your State’s Health Minister separate to the Health Department process.

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Thanks for the feedback. Very good advice. So far when I handed his receptionist my complaint, I gave a copy to the hospital affiliated clinic’s (where he works) chief executive.

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What you wrote is indeed most folk’s attitude, but I think it’s not good enough. Consumers of health care services should not just accept losing the out of pocket expense (in my case $230) not to mention, having to fork out another $400 to another specialist to run the test I wanted.

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Look at it from the perspective that although you were correct, you do not have medical qualifications. The specialist with medical qualifications used his best judgement.

The tests were paid by Medicare in part or full I presume. Would you prefer taxpayers fund whatever tests every patient wants, or as with everything else Medicare, the funds are allocated to deliver the best for the most, using the best advice available to make that determination? The best advice is usually but not always right.

Your $230 paid for the specialists training, knowledge, and experience applied to the highly variable and incompletely understood human condition. Some doctors are better than others, and one might get it right one time and not right the next, and vice versa. Some patients know their bodies well, and some not well at all. How does a doctor differentiate during a 15 minute visit?

If you consider the norm not good enough I encourage you to find a doctor willing to put their support for your refund in writing. or a lawyer to take your case, or the AMA or HCCC to side with you.

A physician refunding a patient for misdiagnosis is unheard of although significant and successful lawsuits for surgeons getting it wrong happen. Doctors are possibly the most protected and insular of professions. Does that make it right and should that be changed? That is an interesting question.

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I thought the matter over more, given 14 days have expired since I wrote to him seeking a refund of my out of pocket expense. I mentioned I wanted the refund within 10 days. That is, I sought the full amount paid less the medicare rebate. I copied this to the clinic director, the clinic is a unit of the hospital.

Today I decided to given him until this Friday to pony up the money or I would (a) seek the refund via NSW Fair Trading; (b) complain to the HCCC for what I consider unprofessional conduct. In fact two GPs agree that him reaching to Rx an addictive medication is not correct protocol, and for what it’s worth © complain to Medicare as it paid him for a diagnosis he must have known was wrong given he treated me for a similar complaint a few years ago. It seems to me that he was stringing me along in order to fleece me for yet another pricey consultation in the future.

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Now you are claiming malpractice. If you have evidence that he knowingly gave a false diagnosis take the evidence to the AMA. Have you got another opinion that says this, if not how do you know? If you don’t have any evidence consider if you are doing the right thing making such accusations.

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Check out Doctor Reviews on Google. I noticed a while back Australia had begun copying the USA by reviewing surgeons etc and I’m not sure how far this went. But worth a look anyway.

From a Health Complaints side firstly, complain that you contacted Doctor X (insert date) to resolve a dispute yourself. Secondly, give the background about the issue (misdiagnosis etc). Thirdly, Doctor X has not bothered to reply. The main issue of a refund may not go anywhere. BUT, the fact that you tried to resolve the issue yourself, the issue was about misdiagnosis and lack of reply means that HC are obligated to investigate. Just make sure you put the complaint in those steps and in that order. Moreover, the complaint ends up on the annual HC Report which may scare Doctor X into contacting you. Note that it will take a couple of months to investigate. The State Website should advise approx. time to respond.

Hope that is helpful

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Thanks for the detailed reply. You make excdellent points.
I think my complaint should have credibility because of my history with this specialist. It is not as though this is the first time I saw him and he merely offered a diagnosis.
The facts are:

  1. I saw him 9 years ago about a similar complaint and he followed what I consider is correct protocol - he investigated and Rx’d non addictive drug that works;
  2. This time not only did he not investigate, but he (a) Rx’d an addictive drug; (b) made claims in his letter to my GP about what he did in the examination (when in fact he did not do any test); and © one claim he made is patently false given the investigation conducted by another hospital proved the exact opposite.

Thanks again.