How Different Medical Practices Are Associated with Types of Patient Complaints in Russian Clinics

Background/Objectives: Patient-Reported Experience Measures (PREMs) help us understand how patients perceive healthcare quality. Yet most studies look at complaints in isolation, without tying them to the structural features of medical practice. This study asks whether the nature of clinical work-shaped by diagnostic pathways, interaction patterns, and professional focus-predicts what patients complain about. Methods: We analyzed 18,492 negative reviews from infodoctor.ru, collected between 2012 and 2023 across 16 Russian cities with populations over one million. We used a mix of methods: machine learning (logistic regression) to classify complaints as medical (M-type) or organizational (O-type), statistical tests (chi-square, proportion analysis), and expert validation by nine independent specialists. We also built a novel multidimensional classification of medical practices based on three criteria: diagnostic pathway length, frequency and duration of patient interaction, and whether the work is mainly technical or communicative. Results: Technical specialties received far more medical complaints than communicative ones (39.8% vs. 29.3%, p < 0.001), while communicative specialties received more organizational complaints (45.7% vs. 35.0%, p < 0.001). Specialties that manage chronic conditions over the long term had the highest share of organizational complaints (41.6%). At the city level, the share of communicative specialists correlated negatively with complaints per capita (r = -0.541, p = 0.0306). We found no meaningful gender differences in complaint patterns. Conclusions: The type of medical practice systematically shapes what patients complain about. Technical specialties draw criticism on clinical quality; communicative specialties draw criticism on how care is organized. Long-term care faces challenges rooted more in administrative friction than in clinical competence. These findings show that PREMs, when analyzed through a practice-based lens, can support targeted quality improvement-moving from simply tracking complaints to acting on them in specialty-specific ways.