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Should Doctors Say ‘I’m Sorry?’

Posted on March 27, 2014 by Kelly Wolford

 
When a doctor makes a mistake resulting in patient harm, the humane thing to do would be to offer an apology. But doctors are often afraid to say “I’m sorry” because they fear it could hurt them in a medical malpractice lawsuit. In other words, they are reluctant to express sorrow or concern when a medical mistake happens for fear they’ll literally pay for their mistake.

However, doctors are protected against this in 36 states. These states prohibit certain statements concerning disclosure or apologies from being admissible in a medical malpractice lawsuit. For patients, this can mean closure or lead to an open dialogue with their physicians. But New York is not one of those states.

Doctors Respond

A recent article at MedPageToday.com asked doctors what they thought about apologizing. Refreshingly, most of the respondents believed being completely open and honest with patients was the best solution for everyone involved.

One doctor explained that physicians know their patients want transparency. But doctors must be trained to apologize and be open. Defensiveness, she said, has no place in the process following a medical error.

Another doctor said physicians need to address errors by explaining what exactly happened in a clear and straightforward manner. The doctor said that it’s crucial to talk to the patient about how you intend to “fix” the error going forward—with that individual patient and future patients.

Doctors recognize the importance of strong, long-term relationships with their patients. Through these relationships, patients learn to trust their doctors and doctors can feel comfortable admitting when something has gone wrong.

Doctors must be open to their patients’ input, a doctor told to MedPageToday. Communication can’t be a one-way street, as patients need to take an active role in decision-making after being informed of risks, errors, and potential outcomes.

Many of the doctors acknowledged that the current system fosters a separation between caregiver and patient, with the doctor in fear of being too compassionate. But as one doctor said, the ideal model doesn’t have to focus on legalities or institutional procedures but on personal relationships.

Empathy, honesty, and communication produce the best results all around, they agreed. But this type of relationship requires courage and transparency from everyone involved, with the goal being the best possible patient care.

Apology Laws Not the Whole Answer

Laws that protect doctors from having their apologies used against them may free doctors to express concern. But such laws don’t solve the majority of problems between doctors and patients.

A study published in the journal Health Affairs found that such laws may actually discourage disclosures and apologies. While that study commends states for taking a front-and-center role in protecting patients from “unanticipated outcomes,” the authors say current apology and disclosure laws don’t solve the problems.

The researchers say that we can’t expect such laws to change a culture where apologies aren’t the norm. In other words, if a narrow law requires an apology or disclosure, the patient will view it as insincere, and it loses value. Rather, they say, the most positive changes can come from institutional support for medical workers having difficult conversations with patients following adverse events.

Doctor apologies and disclosures of medical errors are not a simple matter. Medical mistakes will happen, and those responsible must be accountable for the damage they cause. But the legalities shouldn’t preclude medical professionals from having a compassionate and human relationship with the people they treat.