A gesture of goodwill

Case study

A private GP in New South Wales consults with Lisa, a 33-year-old woman who presents with a recent history of mild intermittent abdominal pain. During the 10-minute consultation, Dr Malik takes a detailed history and advises symptomatic treatment with over-the-counter pain medication. Lisa leaves the appointment feeling dismissed and unclear about the next steps.

That evening, Lisa submits a written complaint to Dr Malik’s practice, stating she felt “rushed”; that “no examination was performed”; and that she had "wasted her money" on a consultation that only left her more confused. She doesn’t use the word “negligence” but is clearly dissatisfied with the service she received.

Following receipt of the complaint, the practice manager and Dr Malik discuss the matter and review the consultation notes. They agree that:

• a detailed history was obtained and well documented
• no examination was performed due to the patient's report of recent mild symptoms
• Dr Malik’s communication about next steps could have been clearer.

Dr Malik sought advice from MDA National on how to respond to the complaint, and he mentioned that the practice manager felt a refund of the patient’s out-of-pocket expenses, as a gesture of goodwill, might be appropriate in the circumstances.

Dr Malik proceeded accordingly, and Lisa received a well-worded response to her concerns, together with confirmation of the refund.

Am I admitting I’ve done something wrong?

Patient complaints are an inevitable aspect of modern clinical practice. While most grievances can be resolved informally, a small number escalate into formal claims for compensation or complaints to a regulatory body. In this landscape, a gesture of goodwill – such as a refund of out-of-pocket consultation fees – can be a pragmatic way to resolve dissatisfaction early and amicably.

Doctors and practices may feel deterred from making a goodwill payment on the basis that it may be seen as an admission of liability. Provided it is carefully worded, a well-timed gesture of goodwill can be an effective, non-litigious resolution tool. When used judiciously, such payments can help preserve doctor–patient relationships, prevent legal escalation, and reduce the emotional toll on doctors.

When is a refund appropriate?

While consideration may be given to a gesture of goodwill payment in any circumstance, it may be most appropriate when:

• there has been a delay or miscommunication
• patient dissatisfaction has occurred due to system-level issues or administrative shortcomings outside of your control
• there has been an error associated with a minor adverse outcome, a treatment complication, or patient dissatisfaction with a treatment outcome.

At the heart of many complaints lies a sense of disappointment, misunderstanding or unmet expectations, rather than true clinical negligence. For these patients, a prompt and empathetic response can offer a sense of validation and closure.

Refunding the cost of the consultation, particularly when a patient feels they received little value or clarity from the interaction, can provide a meaningful acknowledgement of their disappointment. It may defuse tension, signal that the patient’s concerns have been taken seriously, and avoid the adversarial tone that can accompany formal complaint processes or legal proceedings. This proactive approach can often prevent complaints from escalating further – especially when combined with a thoughtful explanation and an invitation to continue dialogue.

In addition to placating a dissatisfied patient, a goodwill payment may decrease the risk of escalation to a regulatory body. Offering a goodwill payment in line with open disclosure principles is likely to support, not hinder, compliance with professional standards. If a patient complaint was made to a regulatory body following a goodwill payment, the earlier conciliatory response provided by a doctor to a patient is likely to be looked upon favourably by the regulator.

Offering a goodwill payment does not mean compromising a doctor’s clinical judgement or professional standards. On the contrary, it can reflect a patient-centred approach that values transparency and compassion. It also demonstrates a willingness to engage constructively with feedback, which is increasingly seen as a marker of quality in healthcare.

Is it just about the money?

While a goodwill payment may be made to a patient in the absence of a written explanation, personalised apologies and acknowledgements may hold more value than the money being refunded. They serve as an expression of empathy and commitment to patient-centred care, and can make a patient feel heard.

Goodwill gestures need not be financial. While they are often in the form of a reimbursement, other examples include offering a free follow-up consultation and patient liaison support.

A copy of the response should be retained on the patient’s file, as well as a note kept on the doctor’s medico-legal file summarising the patient’s complaint or issue, the reason for the goodwill gesture, and confirmation that no liability was admitted.

The circumstances leading to a gesture of goodwill may point to deeper operational issues that need addressing by the doctor and/or the practice. As a part of risk management, a review of how and why an adverse event may have occurred should take place to prevent similar outcomes in the future.

Seek advice

While the benefits of goodwill gestures are compelling, doctors must be cautious as to how such offers are framed. The correspondence accompanying any refund should be meticulously worded to express empathy and a desire to maintain professional trust, without implying clinical fault or negligence. It’s always advisable to seek advice from MDA National before offering a gesture of goodwill.