title: Unsolicited Patient Complaints in Ophthalmology: An Empirical Analysis from a Large National Database.
abstract: OBJECTIVE
  The number of unsolicited patient complaints about a physician has been shown to correlate with increased malpractice risk. Using a large national patient complaint database, we evaluated the number and content of unsolicited patient complaints about ophthalmologists to identify significant risk factors for receiving a complaint.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Ophthalmologists, nonophthalmic surgeons, nonophthalmic nonsurgeons.
  
  
  METHODS
  We analyzed 2087 unsolicited or spontaneous complaints reported about 815 ophthalmologists practicing in 24 academic and nonacademic organizations using the Patient Advocacy Reporting System (PARS). Complaints against 5273 nonophthalmic surgeons and 19487 nonophthalmic nonsurgeons during the same period were used for comparison. Complaint type profiles were assigned using a previously validated standardized coding system. We (1) described the distribution of complaints against ophthalmologists; (2) compared the distribution and rates of patient complaints about ophthalmologists with those of nonophthalmic surgeons and nonophthalmic nonsurgeons in the database; (3) analyzed differences in complaint type profiles and quantity of complaints by ophthalmic subspecialty, practice setting, physician gender, medical school type, and graduation date; and (4) identified significant risk factors for high numbers of unsolicited patient complaints after adjusting for other covariates.
  
  
  METHODS
  Unsolicited patient complaints.
  
  
  RESULTS
  Ophthalmologists had significantly fewer complaints per physician than other nonophthalmic surgeons and nonsurgeons. Sixty-three percent of ophthalmologists had 0 complaints, whereas 10% of ophthalmologists accounted for 61% of all complaints. Ophthalmologists from academic centers, female ophthalmologists, and younger ophthalmologists had significantly more complaints (P < 0.01), and general ophthalmologists had significantly fewer complaints than subspecialists (P < 0.05). After adjusting for covariates using multivariable analysis, working at an academic center was a statistically significant risk factor (adjusted relative risk, 1.82; 95% confidence interval, 1.36-2.43; P < 0.001).
  
  
  CONCLUSIONS
  Ophthalmologists had significantly fewer complaints than nonophthalmic surgeons and nonophthalmic nonsurgeons, and by implication may have a lower malpractice risk as a group. Nevertheless, a small number of ophthalmologists generated a disproportionate number of complaints. Working at an academic center was a significant independent risk factor for having more patient complaints. Further research is needed to clarify the underlying reasons for this association and to identify interventions that may decrease this risk.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee. Electronic address: Sahar.Kohanim@vanderbilt.edu.
authors.forename: Sahar
authors.initials: S
authors.lastname: Kohanim
authors.affiliation: Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Paul
authors.initials: P
authors.lastname: Sternberg
authors.affiliation: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Jan
authors.initials: J
authors.lastname: Karrass
authors.affiliation: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: William O
authors.initials: WO
authors.lastname: Cooper
authors.affiliation: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: James W
authors.initials: JW
authors.lastname: Pichert
mesh_terms: D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007325:Institutional Practice / Q000706:statistics & numerical data; D008297:Male; D008318:Malpractice / Q000706:statistics & numerical data; D009885:Ophthalmology / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011331:Private Practice / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity