Perspectives on Apology in Medicine

Physician checking patient MedPageToday.com recently had a great article talking about the use of apology in medicine. The article featured an assortment of physicians and one lawyer. And, while no one wants to anticipate a medical error, it is a good idea to think about what one would do and how one would handle it, should one occur. One can view it kind of like buying car insurance –no one plans on having an accident, but it’s good to have insurance just in case. While the use of apology isn’t exactly insurance, it’s good to have a strategy or plan in mind of how to handle an error if it happens and to know if apology fits into the plan. As they say, an ounce of prevention is worth a pound of cure (pun intended).

There were several gems that I took away from the article, including:

An apology cannot make up for a lack of bedside manner –and beside manner is under-rated. Physicians should not assume that an apology for a medical error can smooth over the error if there is a poor doctor-patient relationship. Several physicians noted that an apology can be helpful in situations where trust and communication have been built and patients feel like their doctors are genuinely interested in their care and well-being. Should the error occur on top of an already rocky relationship, sorry most likely won’t be enough to fix the situation.

An apology is often best when it is accompanied by 1) what will be done to remedy the situation/medical error and 2) close follow-up.

Humility is necessary for an apology, though difficult and scary. The article talked a lot about how physicians are trained to “know the answer” and how the culture of medicine does not allow for “I don’t know” or wrong answers, much less medical errors. After all, a guiding principle of medicine is, “Do no harm.”

Finally, when talking further about barriers to the use of apology in medical errors, Neil Brooks, MD, had a very interesting take on the topic. He basically said that it’s hard for an apology to work when there isn’t much of a doctor-patient relationship, which he blames on EHRs (often physicians tend to focus on the EHR/computer during the appointment, rather than the patient), lack of touch during appointments (a missed opportunity to build empathy), and promising too much (in terms of outcomes, qualifications/expertise, rankings, etc).

If you are a regular reader of this blog you know that we don’t take a stance on recommending the use of apology or not. We realize that it is a complex question and that our health care providers not only have to answer to themselves and their patients in the event of a medical error, but also to their institution and medical malpractice insurance company. Therefore, we recommend that all of our clients proactively ask their institutions and insurance companies if they support the practice of offering an apology in the event of a medical error. And, we also suggest that health care providers find out if their state has an “I’m Sorry” law too.

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