Key Takeaways
- Patient complaints against IMGs may sometimes arise from communication problems rather than concerns about medical knowledge.
- Patients are more likely to complain when they feel ignored, dismissed or poorly informed.
- Differences in language, tone and healthcare culture can affect how a doctor’s behaviour is interpreted.
- Clear explanations, empathy and safety-netting can reduce misunderstandings.
- Recognising dissatisfaction early gives doctors an opportunity to address concerns before they escalate.
Introduction
International Medical Graduates (IMGs) bring valuable knowledge and experience to healthcare systems around the world. However, working in an unfamiliar language and culture can create communication challenges.
A doctor may believe that a consultation was clinically appropriate, while the patient leaves feeling unheard or uncertain. The problem may not be the medical decision itself, but how the conversation was handled.
Communication difficulties are not unique to IMGs, and not every complaint can be prevented. Nevertheless, understanding what commonly causes dissatisfaction can help doctors communicate more safely and confidently.
Here are five communication problems that can contribute to patient complaints against IMGs—and practical ways to reduce the risk.
1. The Patient Feels Unheard or Interrupted
Doctors often work under considerable time pressure. They may interrupt because they need to gather information efficiently or because they already understand the likely clinical problem.
However, the patient may interpret repeated interruptions as a lack of interest.
For example:
Patient:
“The pain started last week, but I’m particularly worried because—”
Doctor:
“Is it sharp or dull?”
The question may be medically relevant, but the patient’s main concern has not been explored.
A better response would be:
“Before I ask more about the pain, you mentioned that you were particularly worried. Could you tell me what is concerning you?”
Allow patients to complete their opening explanation whenever possible. Brief acknowledgements such as “I see,” “Please go on,” and “Tell me a little more” can show that you are listening.
If you need to redirect the conversation, explain why:
“I’d like to come back to that. First, I need to ask a few questions about the chest pain so that I can assess it safely.”
This keeps the consultation focused without making the patient feel dismissed.
2. The Patient’s Concerns Appear to Be Dismissed
A doctor may recognise that a symptom is unlikely to indicate serious disease. However, reassuring the patient too quickly can sound dismissive.
For example:
“There’s nothing to worry about.”
The intention is reassuring, but the patient may hear:
“Your concern is not important.”
Try acknowledging the worry before offering reassurance:
“I can understand why this has worried you. The examination today is reassuring, and I cannot find signs of anything serious. Let me explain what I think is causing the symptoms.”
This approach recognises the patient’s experience while still giving a clear medical opinion.
Avoid phrases such as:
- “It’s just anxiety.”
- “You’re worrying too much.”
- “There’s nothing wrong with you.”
- “You need to calm down.”
More patient-centred alternatives include:
- “Stress may be contributing to the symptoms, but let’s talk through what you’ve been experiencing.”
- “The tests have not shown anything dangerous, which is reassuring.”
- “I can see that the symptoms are still affecting you.”
- “Let’s discuss what we can do next.”
3. The Diagnosis or Treatment Is Not Explained Clearly
A patient may accept a treatment during the consultation but later feel that they were not properly informed.
This can happen when the doctor:
- Uses too much medical terminology
- Gives several instructions at once
- Does not explain the reason for a treatment
- Moves on without inviting questions
- Assumes that silence means understanding
For example:
“Your results suggest hypertension, so I’ll commence antihypertensive treatment.”
A clearer explanation would be:
“Your blood pressure has remained higher than it should be. Over time, this can increase the risk of heart disease and stroke. I recommend starting medication to help lower it. I’ll explain how the medicine works and the possible side effects.”
The second version explains the condition, why treatment is recommended and what will happen next.
Afterwards, check understanding:
“Just so I know I’ve explained it clearly, could you tell me what you understand about the treatment?”
The purpose is not to test the patient. It is to identify anything that needs to be explained differently.
4. Different Expectations Are Not Explored
Patients and doctors may have different expectations of the consultation.
A patient might expect:
- Antibiotics for an infection
- A scan or specialist referral
- A particular diagnosis
- More time to discuss their concerns
- To be closely involved in the treatment decision
If these expectations are not explored, an appropriate clinical decision may still feel like a refusal.
For example, instead of saying:
“You don’t need antibiotics.”
Try:
“I understand why you were hoping for antibiotics. Your symptoms and examination suggest that this is most likely a viral infection, so antibiotics would not help you recover and could cause side effects. Let’s discuss what you can do to manage the symptoms.”
Useful questions include:
- “What were you hoping we could do today?”
- “Is there a particular treatment you were expecting?”
- “What is your main concern about the symptoms?”
- “How do you feel about the plan we’ve discussed?”
Exploring expectations does not mean agreeing to every request. It allows you to explain your decision in a way that addresses what matters to the patient.
5. Follow-Up and Safety-Netting Are Unclear
A consultation may feel complete to the doctor but leave the patient unsure about what to do next.
Patients need to understand:
- What they should do after the appointment
- How and when they will receive results
- How long recovery may take
- Which symptoms should prompt further help
- Who they should contact if the problem continues
Vague advice such as “Come back if it gets worse” may not be sufficient.
Give specific guidance:
“The cough should gradually improve over the next two weeks. Please seek urgent medical help if you become short of breath, develop chest pain or cough up blood. If the cough has not improved after two weeks, arrange another appointment.”
It is also helpful to check that the patient can follow the plan:
“Could you talk me through what you’ll do if the breathing becomes worse?”
Clear safety-netting supports patient safety and helps prevent misunderstandings about when further care is needed.
Recognising Dissatisfaction Before It Becomes a Complaint
Patients do not always say directly that they are unhappy. Possible signs include:
- Repeating the same concern
- Becoming unusually quiet
- Speaking more loudly or impatiently
- Questioning whether the doctor has listened
- Refusing the proposed plan
- Saying, “You don’t understand what I mean”
If you notice these signs, pause and address them:
“I feel that I may not have fully addressed your concern. Could you tell me what is worrying you most?”
Or:
“You seem uncertain about the plan. What questions or concerns do you still have?”
A brief conversation at this stage may clarify a misunderstanding and restore trust.
If the patient is already upset, remain calm and avoid becoming defensive. Acknowledge their experience, clarify what has happened and explain what can be done next.
Final Thoughts
Patient complaints against IMGs are not always caused by poor English or poor clinical care. They may arise when a patient feels unheard, dismissed, uninformed or uncertain about the plan.
Many of these problems can be reduced through small communication changes: allowing the patient to finish, acknowledging concerns, explaining decisions clearly and giving specific safety-netting advice.
The aim is not to avoid every disagreement or promise that a patient will never complain. It is to create consultations in which patients feel respected, informed and involved.
For IMGs, practising difficult conversations and receiving specific feedback can make these skills feel more natural. The result is not only better patient experience, but also greater confidence when managing challenging consultations.
Book a consultation to discuss your goals and see how I can help.