In the past, the possibilities in medicine were more limited and the system was not complete. But there was a bond of trust between the physician and the patient. The patient would deliver his/her problem and the physician would do his/her best to cure it. The main thing that has changed today is exactly this relationship.
The complaint mechanisms established in the field of health in recent years were, at first glance, responding to a legitimate need. The aim was to facilitate citizens' means of claiming their rights, to receive feedback on public services and to increase transparency. CIMER was established in this framework. In terms of its founding intentions, the issue was access to the state, not the oppression of physicians or public employees.
However, the picture that emerged in practice did not match this intention.
Today, most of the applications in the field of health are related to communication, behavior, waiting time and expectation management rather than medical errors. Moreover, they no longer go to the chief physician's office, but directly to CIMER. This is because CIMER is perceived as a stronger and more result-oriented channel in the eyes of the patient.
This is where the problem begins. Many applications come directly to the physician without being pre-screened and assessed in their medical context.
It is not possible to understand the impact of this mechanism without seeing the environment in which a physician works during the day. Throughout the day, he/she sees patients in outpatient clinics, wards and emergency rooms; he/she makes decisions and takes responsibility. In the midst of this intensity, a patient petition is placed in front of him/her with the warning “submit your defense within a week”. The content is often not a medical error, but a postponed procedure, a changed room or an unmet expectation. This picture reduces medicine from a profession that is driven by knowledge and conscience to one that has to constantly explain itself.
A physician who works with a constant sense of defense cannot produce good service. Because his mind is focused on self-protection, not on the patient. Medical reasoning is replaced by the reflex of self-protection. The question “what is the right thing to do?” is replaced by “don't give me a headache”. This situation does not reduce error; on the contrary, it paralyzes the ability to make qualified decisions. A system that positions the physician as a potential criminal at every step does not produce safe medicine; it produces cowardly medicine.
A health practice based on fear is neither healing for the patient nor security for society.
Has this complaint mechanism really improved service quality?
Apparently, it has not increased. On the contrary, it has changed physician behavior. For many physicians, the main determinant is no longer “what is right” but “what will not cause problems”. Unnecessary examinations, unnecessary referrals and unnecessary procedures have increased. In the medical literature, this is called defensive medicine. Defensive medicine does not increase safety; it compresses the practice of medicine into an inefficient and cautious area.
Of course there is and should be a right to complain. However, in a technical and vital field such as health, these applications must pass through a sifting and professional evaluation filter. Accepting every application as it is does not strengthen the right; it weakens the system.
A society is as healthy as the space it gives to its physicians.
This is because medicine is not a job done by instruction, but by knowledge, judgment and responsibility. When the physician is denied time, authority and trust, the right decisions are replaced by seemingly safe but inefficient practices. In such a system, health does not improve; only risk is managed.
Note
This article is based on the general academic literature, professional observations and experiences of physicians working in the field on the effects of grievance mechanisms on physician behavior in health services in Turkey.