The MD Daily Contract review

September 17, 2018 • By Guest

The power of apology


Medical errors are the third leading cause of death in the United States.1 Many patients want to hear the physician apologize after a medical error has been made and, ironically, many physicians want to apologize. However, confusion about what can and cannot be said after a medical error leads to needless suffering by all involved parties.

What do patients want?

Generally, patients who pursue litigation after medical errors do so to achieve four goals2:

  1. To understand what went wrong: patients want to know the circumstances surrounding the medical error and what—if anything—could have been done to prevent it
  2. To make sure it doesn’t happen again: patients want to maintain a baseline standard of care so that others don’t suffer from the same error
  3. To hold someone accountable: patients want the party at fault to take responsibility and apologize for the error
  4. To be compensated: patients want their pain and suffering—as well as any objective losses—to be acknowledged and recuperated

An apology recognizes wrongdoing, accepts responsibility and communicates sincere remorse for causing harm with an eye to ensuring it will not recur.3 Therefore, apart from the last, all of patients’ concerns can be fully satisfied by a sincere and heartfelt apology. Furthermore, an apology allows the patient to come to terms with the medical error, have their feelings of anger and sadness acknowledged and begin to heal emotionally.

What do physicians need?

Physicians are incredibly sensitive to medical errors. Physicians who make medical errors feel they have failed professionally and personally. This is distressing as the physician must come to terms with her role as a healer in light of her ability to cause harm.3 Understandably, many physicians also fear legal actions that follow medical errors. As such, physicians may refuse to discuss the error, minimize it, and avoid the affected patients. Unfortunately, this behavior is in direct opposition to the patient’s desire.4

Most physicians, like most patients, want to work through these complex emotions through open dialog. An apology is an excellent first step to start the healing process.4 While it can be uncomfortable to apologize initially, acknowledging a mistake may help resolve internalized shame and provide space not only for patients’ forgiveness, but also for self-forgiveness. In addition, an apology restores trust in what may be a tenuous relationship with the patient, especially if the physician-patient relationship must continue. 

What does the law say?

The legal system has evolved to permit this sort of interaction. Indeed, 35 states have so called “apology” laws that make apologies inadmissible as evidence in court. This foundations of these laws is that apologies help to change the atmosphere from anger to healing, and may reduce time spent in adversarial legal proceedings.

Importantly, however, physicians must know if they are in one of the 35 states that permit an apology without legal jeopardy. Moreover, while saying, “I am sorry” is inadmissible in these states, saying “I made a mistake” is admissible.

How can we move forward?

Apologies are a simple and heartfelt way to express remorse, provide information, and rebuild a trusting relationship between physician and patient following a medical error. As such, the medical community is warming to apologies. Since the University of Michigan Health System implemented its “full disclosure program” in 2001, the monthly claims rate dropped by 36 percent while lawsuits dropped by 65 percent.5 Medical schools are catching on and training student on medical errors, communication, and apologies.6

Good communication makes for good patient care. Patients seek understanding and want their pain to be acknowledged. Physicians, on the other hand, also have an important psychological need to seek forgiveness. Some states allow them to receive this personal absolution without risking further legal exposure. While injured patients can and will still seek damages in court for medical errors, a heartfelt and sincere apology can serve the interests of all parties involved, and may diffuse some of the tensions that feed the emotional aspects of legal actions.

References

1. Makary MA, Daniel M. Medical Error—the Third Leading Cause of Death in the Us. BMJ. 2016;353. doi:10.1136/bmj.i2139

2. Vincent C, Young M, Phillips A. Why Do People Sue Doctors? A Study of Patients and Relatives Taking Legal Action. Lancet. 1994;343(8913):1609-1613.

3. Robbennolt JK. Apologies and Medical Error. Clin Orthop Relat Res. 2009;467(2):376-382. doi:10.1007/s11999-008-0580-1

4. Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients’ and Physicians’ Attitudes Regarding the Disclosure of Medical Errors. Jama. 2003;289(8):1001-1007.

5. Kachalia A, Kaufman SR, Boothman R, et al. Liability Claims and Costs before and after Implementation of a Medical Error Disclosure Program. Ann Intern Med. 2010;153(4):213-221. doi:10.7326/0003-4819-153-4-201008170-00002

6. Halbach JL, Sullivan LL. Teaching Medical Students About Medical Errors and Patient Safety: Evaluation of a Required Curriculum. Acad Med. 2005;80(6):600-606.

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