Apology in Medical Practice: A Changing View
Whether it is an inadvertent act of running over a family’s pet cat or a physician’s medical error, an apology is the decent and humane act to provide those suffering the result of the act.
Apology is particularly needed in the medical profession where unintended errors or errors due to carelessness or ignorance can occur with degrees of injury leading up to death of a patient. And yet, it has only been in recent years that the value of apology was stressed. In the past complications of diagnosis or treatment that were ignored, not fully explained or explained without admission of personal responsibility. In the past, apology by a physician for a consequence in medical care was considered an invitation for a malpractice lawsuit and physicians were advised by some lawyers and hospital risk-management staff to be empathetic in their response to the patient or family (“I can understand how you feel and it must be very upsetting”) but nothing further since anything suggesting an apology would be an admission of guilt if the case was brought to trial.
Recent experience with apology and an offer of helping to compensate has suggested that less malpractice legal actions are taken. The therapeutic value of an apology cannot be underestimated. It can change the uncertainties and anger of a patient or family into one of understanding and tolerance.
To read more about the benefit to all for doctor’s to apologize, you can go to the “Sorry Works Coalition” website Also read the Forward by Robert Ward for the book “On Apology” by Aaron Lazare which provides some historical background. Finally, you can read a personal response to a physician’s apology by Trisha Torrey on About.com: Patient Empowerment.
An apology is an act for one human being to offer to another which is a sign of humanism and understanding but also can be a form of therapy to the potential suffering of the other.
..Maurice.
Graphic: Digital photograph taken by me today of a neighborhood sign.
posted by Maurice Bernstein, M.D. @ 9:27:00 PM
4 comments
4 Comments:
Our pediatrician once made a mistake and called me and personally apologized for it. She didn't have to do that. I was really impressed because it's a difficult thing to admit and it does make her vulnerable. But she did it because it was the right thing to do.
Part of the problem is that we as a society expect perfection from physicians. Obviously where health and life are concerned, being error free as possible and having checks in place are important, but people are still human. It's the aspect that would scare me most about being a physician, making mistakes. Personally I could accept some kinds of mistakes knowing that they're honest mistakes or cognitive errors, as opposed to intentional negligence or incompetence.
An apology to me would mean more if it was sincere in that I know that the physician won’t make or allow that mistake happen again. I live in a small community and when medical mistakes happen at our surrounding hospitals, its gossip. Last week a 27 year old man went to the ER with chest pain complaining that he thought he was having a heart attack, both the ER doctor and surgeon agreed that it was his gallbladder causing the pain so he was rushed to surgery to have it removed. When he woke up, he wouldn’t stop bleeding and the pain got worse. When they finally found the problem, it was too late. They rushed him to another hospital for emergency heart surgery as he had a tear of his aortic valve and even though he made it through the surgery; his other organs were without blood for so long they wouldn’t function. He was supposed to get married in a few weeks. That was tragic and when something like that happens in a small town, if affects everyone. I still know a few people that work at the hospital and I asked one nurse who works in the OR with him if he seems to be phased by it, she said that he doesn’t and he hasn’t admitted any fault at all. I realize that the surgeon wouldn’t come out and say to the staff that he made a mistake for legal reasons (or the OR doctor) but to act as though it never happened, I just don’t understand. I asked my wife if in the time she worked at the hospital if she ever heard a physician say that they made a mistake (there were plenty) and she said no one, even the obvious ones that she could spot by just going through the medical records. I think it would be therapeutic to all if that happened more and I’m a person who would prefer to hear an apology instead of an excuse. In the end, that may make that person a better doctor and give the family some closure. Jimmy
Jimmy and others: how would you separate an apology from an excuse? Is it more than an explanation of what happened? Is it more than "I'm sorry"? Is it saying outright "This happened because of a fault on my part"? What if the doctor said "This happened because of an accident on my part?" What part of the communication sets it as an apology and not an excuse? In the case described by Jimmy, how would you phrase what the doctor should say to the family? ..Maurice.
Dr.Bernstein
I honestly don’t know how you could phrase what happened to the family. I know that I wouldn’t want to hear it from a different doctor that pronounced your son dead at a different hospital. I guess an apology followed by reasons why you approached the case as you did would be enough for me. I myself can accept an honest mistake (we’re all humans) but not knowing and staying silent when you need answers and hurting isn’t showing compassion. A family needs closure more than anything so they can move forward and not dwell on the past. That’s just my feelings… Jimmy
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