To cite: Gallagher TH, Levinson W. Quality and Safety in Health Care Published Online First: [please include Day Month Year] doi:10.1136/bmjqs-2013001880 Patients are generally pleased with their personal physicians and appreciate positive relationships with them. In the recent Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey of patients in nearly 4000 US hospitals, 81% of patients gave the highest marks possible to their communication with their physicians. Yet some physicians struggle to interact effectively with patients. The majority of problematic patient–provider interactions go unnoticed, except by the patient. The physicians do not receive feedback and may be unaware that their patients are dissatisfied. Sometimes patients who have had a poor interaction with their physician file a complaint, either with the healthcare institution or with a regulator such as a state Board of Medicine. Prior research, along with the study by Bismark and colleagues in this issue, highlight how a small number of physicians are responsible for the majority of patient complaints. Similar findings have been demonstrated previously for other markers of problematic patient–provider interactions such as malpractice claims, when a small minority of physicians are responsible for the majority of lawsuits. 5 Given the fact that many patients who are unhappy with the communication with their physicians hesitate to complain, the current data on the prevalence of patient complaints represent the tip of the iceberg. Some organisations are systematically examining patient complaints to understand and improve providers’ communication skills and patient satisfaction. Furthermore, patient complaints are associated with other measures of gaps in quality of care. However, historically the medical profession has not taken patient complaints especially seriously. Multiple formal patient complaints or allegations of egregious behaviour about an individual physician are often required before regulators investigate. The rigorous study by Bismark and colleagues documents just how pervasive and concerning the problem of physicians with recurrent patient complaints is. Three percent of Australian physicians accounted for 49% of patient complaints, and 1% accounted for 25% of patient complaints. Physicians who accumulated multiple prior complaints were highly likely to experience future complaints. As with prior studies, the problems that generated the complaints included a mixture of patient concerns about clinical care and communication breakdowns. 8 9 While the study was conducted in Australia, it is very likely that the findings would be similar in North America, the UK and elsewhere. The profession’s reticence to respond to patient complaints is concerning in multiple respects. The failure to detect and remediate patient care breakdowns represents a fundamental breach of patientcentred care. Patients need clinicians and the healthcare system to listen to their concerns and use them to improve care for themselves and other patients. Our lack of response to individual physicians who accumulate multiple complaints demonstrates an insufficient commitment to being a truly self-regulating profession. Through our silence we fail to intervene at an earlier stage to improve the communication skills and the quality of care provided by our colleagues. This silence abandons our colleagues but more importantly the future patients with whom these physicians will interact.