(Pub­lished in The Huff­in­g­ton Post)

On a late Sun­day night one recent long week­end, I was con­tact­ed by a fam­i­ly who was dis­tressed over the treat­ment their elder­ly father was receiv­ing in the hos­pi­tal. I oper­ate an online out­reach clin­ic for patients and fam­i­lies through The Cen­ter for Patient Pro­tec­tion. It has helped thou­sands over the years nav­i­gate their way toward safer care and deal with the emo­tion­al trau­ma of med­ical errors when they occur.

The fam­i­ly who reached out to me believed the care team had made some seri­ous errors in treat­ment and were not com­ing clean with what had hap­pened. There had been a com­plete break­down in com­mu­ni­ca­tion and trust between the fam­i­ly and the doc­tors and nurs­es involved.

The fam­i­ly felt their con­cerns were resent­ed and that they had been por­trayed as “dif­fi­cult” in a way that was jeop­ar­diz­ing the best care for their father. Hav­ing known dark nights of despair in the lengthy hos­pi­tal­iza­tion of my own moth­er, I find it dif­fi­cult to turn away such cries for help.

At most hos­pi­tals, patient rela­tions (com­plaint) depart­ments are closed just when they are need­ed the most — on week­ends and hol­i­days. This hos­pi­tal was no excep­tion. The fam­i­ly told me they had nowhere else to turn.

I spent much of the rest of the week­end help­ing to restore the rela­tion­ship between the fam­i­ly and the care team. The hos­pi­tal final­ly agreed to be forth­com­ing with the fam­i­ly about the mis­takes that had occurred and offered an apol­o­gy for what had hap­pened. This helped to get every­one back on the same page. The fam­i­ly lat­er told me they saw real ben­e­fits to the patient as a result. Not all pleas for help have a hap­py end­ing.

The line between being “con­cerned” and “dif­fi­cult” in the eyes of the care team is a thin one that fam­i­lies can eas­i­ly find them­selves cross­ing.

Fam­i­lies are often experts on a hos­pi­tal­ized loved one. They are fre­quent­ly the first to rec­og­nize adverse changes in the patien­t’s con­di­tion that are impor­tant for health-care pro­fes­sion­als to act upon. They under­stand the pref­er­ences of the patient, which can also assist with ensur­ing a more com­fort­able hos­pi­tal stay. And fam­i­lies pro­vide patients with a unique lev­el of per­son­al care, sup­port and reas­sur­ance no clin­i­cal team can match, no mat­ter how well-intentioned.

Fam­i­lies know best

These prin­ci­ples are enshrined in the idea of patient and family-centred care, which rec­og­nizes how impor­tant fam­i­lies can be to suc­cess­ful patient out­comes, and the roles that respect, open­ness and con­sul­ta­tion with fam­i­lies play in that process.

Our health-care pro­fes­sion­als and hos­pi­tals reg­u­lar­ly pro­vide a mar­vel­lous range of care and even hero­ic achieve­ments. They do this every day. But far too often, this face of health care can become eclipsed by shad­ows of opaque­ness and resent­ment that reveal a dark­er side of our health-care sys­tems, espe­cial­ly when it comes to the search for account­abil­i­ty by harmed patients and fam­i­lies.

Just look at the lit­er­a­ture on the prob­lems with trans­paren­cy and dis­clo­sure of avoid­able med­ical errors, and the com­mon­ly report­ed reluc­tance of physi­cians to admit to hav­ing made an error or caused injury to a patient. Med­ical lit­er­a­ture is also replete with ref­er­ences to the “deny and defend ” cul­ture to which providers some­times resort when patients and fam­i­lies seek account­abil­i­ty for adverse inci­dents.

This same dark side often unleash­es a tor­rent of emo­tion­al harm. As Sir Liam Don­ald­son, M.D., one of the world’s most respect­ed and con­sult­ed experts on patient safe­ty, reminds: “Too often, health-care orga­ni­za­tions, through their inept and unfeel­ing respons­es, ampli­fy these lat­er waves of harm rather than mit­i­gate their dam­ag­ing effects.”

Denial nev­er leads to pos­i­tive out­comes

Over the years, many patients and fam­i­lies have con­tact­ed me to report their ordeals involv­ing care that was not respect­ful, health-care pro­fes­sion­als who did not ade­quate­ly respond when adverse signs were begin­ning to appear or hos­pi­tals that did not pro­vide answers when errors occurred. In our strained and busy health-care sys­tems today, the line between being “con­cerned” and “dif­fi­cult” in the eyes of the care team is a thin one that fam­i­lies can eas­i­ly find them­selves cross­ing. When this hap­pens, it gen­er­al­ly does not have a good out­come.

All this stands in stark con­trast to the mis­sion of com­pas­sion­ate care and heal­ing that is at the heart of these noble pro­fes­sions. Health-care cul­tures that will not acknowl­edge or admit to med­ical errors, and there­fore fail to learn from them, or per­mit expres­sions of resent­ment and dis­re­spect by care teams (and admin­is­tra­tors) to patients and fam­i­lies seek­ing infor­ma­tion are the very antithe­sis of what patients need and what a car­ing soci­ety should accept.

Such cul­tures also trans­late into high­er health-care costs for every­one, which can run the gamut from longer hos­pi­tal stays result­ing from med­ical errors to lit­i­ga­tion that can arise when nei­ther answers nor apolo­gies are forth­com­ing.

Account­abil­i­ty is at the cen­tre of a trust­ed health-care sys­tem

Human error is nev­er inten­tion­al in the care of a patient. We all know this. But the refusal to make things right, to own up to the error and to seek for­give­ness for any result­ing phys­i­cal and emo­tion­al injury, espe­cial­ly when they might have been pre­vent­ed, is always an act of inten­tion.

And before any­one takes great offence to this the­sis, try walk­ing in the shoes of patients — and also think of the sur­viv­ing fam­i­ly mem­bers who have had to deal with the impact of avoid­able med­ica­tion errors, pre­ventable hospital-acquired infec­tions or botched sur­gi­cal pro­ce­dures that need­n’t have hap­pened.

These events often result in over­whelm­ing feel­ings of aban­don­ment and betray­al in the after­math of harm where fam­i­lies can remain haunt­ed by feel­ings of guilt and the curse of “what ifs” — some­times for the rest of their lives. It is a night­mare from which too many vic­tims nev­er ful­ly awake, as I see with the heart­bro­ken souls who reg­u­lar­ly con­tact me.

Sure­ly our health-care providers and pro­fes­sion­als can do bet­ter. In a sys­tem that is as depen­dent upon trust and respect as it is on med­ica­tion and anti­sep­tics, we can­not afford two faces of health care. There should only be one: where the well-being of the patient and fam­i­ly, and their need for hon­esty, dig­ni­ty and com­pas­sion, come first.