It’s time for a top‐to‐bottom review of just how user‐friendly and fair our health­care com­plaint bod­ies real­ly are. 

You expect that casi­nos are going to be slant­ed in favor of the house. But you don’t imag­ine those kind of odds when it comes to com­plaints about hos­pi­tals and health­care providers that may have caused avoid­able med­ical or emo­tion­al harm.

In Ontario, every hos­pi­tal is required to have a patient rela­tions office to deal with con­cerns raised by patients and fam­i­lies. Oth­er provinces have sim­i­lar require­ments as do most U.S. states. Many patients and fam­i­lies mis­tak­en­ly believe hos­pi­tal com­plaint depart­ments are inde­pen­dent and are there to advo­cate on behalf of them. It’s a quaint notion that quick­ly van­ish­es when those look­ing for help dis­cov­er these offices are lit­tle more than adjuncts of a hospital’s admin­is­tra­tion. Noth­ing they do will be con­trary to what the hos­pi­tal sees as being in its best inter­ests.

Uni­ver­si­ty Health Net­work, for instance, says you can appeal any deci­sion of a patient rela­tions coor­di­na­tor. But you will be appeal­ing it to the same depart­ment that made the deci­sion in the first place. How objec­tive do you think that’s going to be?

No hos­pi­tal com­plaint depart­ment I know of pub­licly dis­clos­es the num­ber of com­plaints it receives and their out­come in a sta­tis­ti­cal form. This only rein­forces the impres­sion of a cul­ture of secre­cy and self‐interest, which explains why so many patients and fam­i­lies reg­u­lar­ly report their dis­sat­is­fac­tion with hos­pi­tal com­plaint depart­ments to my non‐profit advo­ca­cy, The Cen­ter for Patient Pro­tec­tion.

The view that hos­pi­tals need to do a bet­ter job of han­dling com­plaints is not con­fined to patients and fam­i­lies. A paper recent­ly pub­lished in the respect­ed British Med­ical Jour­nal called on health­care sys­tems and providers to shift their com­plaint focus “from efforts to mol­li­fy and avert pub­lic­i­ty to iden­ti­fy­ing root caus­es and improv­ing care….”

Where else can patients and fam­i­lies turn if they’ve expe­ri­enced harm? If the com­plaint involves the actions of a doc­tor in Ontario, they might look to its Col­lege of Physi­cians and Sur­geons. Here again, the deck is stacked against ordi­nary patients and fam­i­lies. Com­plaints are typ­i­cal­ly decid­ed by a pan­el that includes three med­ical pro­fes­sion­als (MDs) and only one layper­son appoint­ed to rep­re­sent the pub­lic.

Its most recent sta­tis­tics show that in six out of ten cas­es, the Col­lege took no action what­ev­er on a com­plaint. If the Inquiries, Com­plaints and Reports Com­mit­tee (ICRC) — the Col­lege body that adju­di­cates on com­plaints from mem­bers of the pub­lic — finds that a doc­tor has not lived up to some aspect of his or her pro­fes­sion­al oblig­a­tions, it may choose to qui­et­ly issue a “reminder” to the doc­tor in the form of rec­om­men­da­tions or “advice.” Or it might issue a writ­ten “cau­tion.” These out­comes hap­pened on 662 occa­sions in 2014, or in 63 per­cent of the cas­es where action was tak­en.

The prob­lem is that this infor­ma­tion is nev­er made acces­si­ble to mem­bers of the pub­lic who may want to check up on a doctor’s record — just before surgery, for instance. Per­haps most telling, the ICRC referred the con­duct of a doc­tor to the College’s dis­ci­pli­nary com­mit­tee for fur­ther action in less than three per­cent of all the cas­es it reviewed.

Add to all this the fact that doc­tors fac­ing com­plaints from mem­bers of the pub­lic in Cana­da are usu­al­ly rep­re­sent­ed by high‐priced lawyers who are fund­ed by the taxpayer‐subsidized Cana­di­an Med­ical Pro­tec­tive Asso­ci­a­tion and you quick­ly get the impres­sion that the odds don’t favour the aver­age patient and fam­i­ly. This only mag­ni­fies the sense of emo­tion­al harm that too many patients and fam­i­lies suf­fer at the hands of a health­care care sys­tem dom­i­nat­ed by entrenched inter­ests.

In Ontario, deci­sions of the Col­lege of Physi­cians and Sur­geons can be appealed to some­thing called the Health Pro­fes­sions Appeal and Review Board. Now that’s real­ly a casi­no where the house wins.

In the past two years, 90 per cent of the cas­es the board dis­posed of con­firmed the orig­i­nal deci­sion of the health­care reg­u­la­tor. In oth­er words, 9 times out of 10 those appeal­ing the out­come of their com­plaint got noth­ing for their trou­ble.

On the sur­face, all these fig­ures might sug­gest that there’s not real­ly a prob­lem with our health­care sys­tem. The facts tell a dif­fer­ent sto­ry. Just based on the fig­ure pro­vid­ed by Uni­ver­si­ty Health Net­work (which I think falls on the low end), med­ical errors and hospital‐acquired infec­tions togeth­er claim more lives every year than strokes, Alzheimer’s, kid­ney dis­ease, breast can­cer and acci­dents involv­ing cars, trains and air­lines com­bined.

The fail­ure of Canada’s pub­lic health­care sys­tems to deliv­er mean­ing­ful account­abil­i­ty mech­a­nisms to patients and fam­i­lies has sparked at least one pri­vate sec­tor busi­ness ini­tia­tive. For an upfront fee of as much as $1050, this web‐based ser­vice will assess a poten­tial case for med­ical mal­prac­tice. But as I sug­gest­ed in a Nation­al Post inter­view this week, that approach may wind up tak­ing those who have suf­fered harm down a stress­ful and cost­ly lit­i­ga­tion path that sta­tis­tics show rarely works in favour of ordi­nary patients and fam­i­lies, and where if you lose, you may wind up pay­ing the oth­er side’s costs.

The same kind of insti­tu­tion­al bias­es and bar­ri­ers to the fair han­dling of patient and fam­i­ly com­plaints cit­ed above have their par­al­lels else­where, includ­ing the Unit­ed States and the Unit­ed King­dom.  In Cal­i­for­nia, there is a move afoot to end self‐regulation by doc­tors and replace mem­bers of that state’s med­ical licens­ing board with inde­pen­dent mem­bers of the pub­lic.

Account­abil­i­ty is an essen­tial com­po­nent in achiev­ing a safer health­care sys­tem. So is pub­lic con­fi­dence. But as long as mech­a­nisms to ensure account­abil­i­ty are not user‐friendly, hos­pi­tal com­plaint pro­ce­dures and dis­ci­pli­nary bod­ies are dom­i­nat­ed by insid­ers and deci­sions are shroud­ed in secre­cy, pub­lic con­fi­dence will sure­ly be under­mined. And so will patient safe­ty.

It is time for a top‐to‐bottom review by gov­ern­ments in all juris­dic­tions, with sub­stan­tial input from patients and fam­i­lies, of how well our hos­pi­tals and pro­fes­sion­al health­care bod­ies are actu­al­ly deliv­er­ing account­abil­i­ty and trans­paren­cy, and whether they are doing it in the user‐friendly, com­pas­sion­ate and respect­ful man­ner that gen­uine patient and fam­i­ly engage­ment requires.

Until that hap­pens, patients and fam­i­lies may wish to seri­ous­ly rethink whether they should be accord­ing any legit­i­ma­cy to these com­plaint mech­a­nisms by par­tic­i­pat­ing in a rigged game that rarely offers sat­is­fac­tion and often pro­duces still more waves of emo­tion­al harm.