Medical mediation, experience, and lessons learned

INTRODUCTION
This study provides a review of complaints and mediations at the University Hospitals of Strasbourg, France. It describes the main themes of dissatisfaction expressed by patients or their families.
The aim is to identify lessons and/or actions for improvement to be passed on to doctors and nurses, as well as to medical and nursing students.

MATERIALS AND METHODS
We reviewed and analyzed cases handled by a mediator over a 3-year period.

RESULTS
Seventy-nine mediations out of 265 (30%) processed from January 2019 to December 2022, were analyzed. They corresponded to the activity of one of the hospital’s three medical mediators.
The majority (62%) of grievances were sent by post and 19% by email. Only 11% of complaints were expressed and detailed over the phone, with the hospital’s Quality Department secretariat as the contact person. In 8% of cases, the discharge questionnaire had relayed a patient’s dissatisfaction.
Complaints were most often addressed to the General Management (66%). Copies of the complaint were sometimes sent to the local newspaper, the director of the Regional Health Agency (ARS), the French Medical Association (Ordre des Médecins), certain members of parliament, the President of the French Republic or his wife.
The claimant is most often a woman (73%). In this case, it is the patient, for herself (20%).
When a man complains about the hospital, in 60% of cases it is related to him.
In 24% of cases, the death of a spouse or close relative is the context for the complaint.
Several themes may be the subject of mediation, one not excluding the other. As a result, the total percentages may exceed 100.
Claimants want answers to their questions, redress or compensation, and sometimes request the transmission of their medical records.
Their stated aim is as follows: "To prevent this from happening to others", "Never again".

1) Problems related to individuals:

LACK OF INFORMATION WAS THE MAIN SUBJECT OF MEDIATION (53%). Information provided to patients or their families was deemed insufficient or delayed. The lack of seniority in the announcement and follow-up interviews was a recurring complaint.
Information delivered by different people may appear fanciful or contradictory.
Words that precisely define the pathology are often misused in favor of non-informative vocabulary.
There may be a lack of information flow between healthcare personnel.
When information is not clear to the patient or family, when it is delayed without particular justification, when it is contradictory, or when it is absent, doubt is created. In 15% of mediations, the lack of information contributed to the evocation of a potential "medical error".

ABNORMAL BEHAVIOR ON THE PART OF DOCTORS OR CAREGIVERS TOWARDS PATIENTS OR THEIR RELATIVES ACCOUNTED FOR 49% OF MEDIATIONS. One complainant defined this perfectly: "all those little things that don't make a good impression", which discredit the patient and add substance to the complaint and the subject of the mediation.
We often regret "a form of infantilization".
In 13% of mediations, the notion of an abusive caregiver or abusive institution is raised.
The lack of respect for professional ethics shocks and reinforces the dissatisfaction of some complainants.

LACK OF PAIN MANAGEMENT CONCERNS 14% OF MEDIATIONS.

2) Systemic hospital problems:

EMERGENCY DEPARTMENTS ARE AT THE HEART OF 19% OF MEDIATIONS. Conditions in emergency departments are sometimes described as inhuman.
Relatives of the elderly, dependent or handicapped, or of clinically deteriorated patients, regret not having been accepted in the ER to accompany and help, or even reassure, and pass on information about the patient to the rest of the family.

IN 17% OF MEDIATIONS, "HASTY" DEPARTURES FROM HOSPITAL WERE COMBINED WITH OTHER NEGATIVE COMMENTS. Poorly announced or inadequately prepared departures can lead to difficulties for patients and their families.

TRANSFERS FROM ONE DEPARTMENT TO ANOTHER AT ANY TIME OF THE DAY OR NIGHT, AND SOMETIMES WITHOUT INFORMING THE FAMILY, AND THE DEVELOPMENT OF "BEDS", testify to the scarcity of beds in hospitals and the desire to "pool resources".

3) Miscellaneous:

The impression of an "escaped" end of life, a conflict between a doctor and a patient, the COVID pandemic period, deprogramming, loss of objects, suspicion of theft, receipt of a bill for ineffective care, an abusive bill for services not rendered, poor accommodation conditions, the quality of the food, the atmosphere of certain departments, the behavior of some, inappropriate care, a lack of availability, a lack of empathy, appear to be catalysts for complaints.

DISCUSSION

The total number of complaints (265) must be set against the number of hospitalizations (555,449) over the same period.
Insufficient or inappropriate medical information raises many questions and generates doubt. Confidence in caregivers is eroded, and the notion of a possible error that doctors would like to conceal takes root.

Time spent with patients and/or their families is essential to providing quality information.

In 2023, the hospital doctor is no longer constantly at the patient's bedside. Changes in the organization of medical work and the digitization of information are creating new risks that we need to address.

Inappropriate behavior, in a place where the objective is to "take care of...", generates unease among patients and their families.