Should Docs Rethink Saying 'I'm Sorry' After a Medical Error?

Leigh Page


July 17, 2019

In a 2006 study, two thirds of US and Canadian doctors agreed that disclosing a serious error reduces malpractice risk.[5] However, in a 2017 Medscape survey, 83% of doctors who were involved in malpractice lawsuits said that saying, "I'm sorry" wouldn't have changed the outcome.[6]

Physicians' Views on Apologizing

Even when physicians seriously considered apologizing in the 2000s, they were always very wary of how much to tell patients about errors. In addition to fear of lawsuits, they worried about the shame of having to recognize their error, and they do not know how to go about apologizing, according to one report.[2]

Studies also have shown that many doctors do not want to acknowledge the full extent of an error to patients.

For example, when asked how they would portray a delayed diagnosis of breast cancer and a delayed response to symptoms due to poor coordination of care, more than 70% of primary care physicians said they would provide "only a limited or no apology, limited or no explanation, and limited or no information about the cause," according to a 2016 study.[7]

In a 2006 study of physicians, 42% said they would explicitly state that an error occurred, but 56% chose statements that mentioned the adverse event but not the error. If an error was caused by the surgeon's lack of familiarity with a new device, only 21% would disclose that fact to a patient.[2]

The study showed that surgeons are generally less willing than primary care physicians to reveal errors: Although 58% of medical specialists would explicitly mention an error, only 19% of surgical specialists would do so.

Should Physicians Have to Apologize for Judgment Calls?

Cotton says the problem facing physicians is complicated. "A lot of incidents that are termed errors or mistakes are really judgment calls," he says. In the operating room, for example, the surgeon constantly has to decide, "Do I cut here? Do we try to move this muscle, or that nerve?"

"If the patient then ends up losing a lot of blood, is that an error that should be reported to the patient? In retrospect, the surgeon should have used a different technique, but that's hard to know when you're in the middle of it," Cotton says.

Cotton makes a distinction between judgment calls and "moral wrongs," such as lying or stealing from someone.

If you commit a moral wrong against someone, you should apologize.

"If you commit a moral wrong against someone, you should apologize," he says. But a surgeon who "inadvertently injures a nerve during a complex procedure" has not committed a moral wrong, he says. "The physician needs to give his best effort."

Cotton contends that expecting doctors to confess everything to patients is unrealistic. "The concept of saying I'm sorry was invented by risk officers at hospitals and malpractice insurance carriers, not doctors," he says. "Should physicians have to apologize each time they make a judgment call?"

Expecting Perfection Is Unrealistic

Should physicians tell patients about judgment calls that don't work out? asks Keith S. Naunheim, MD, thoracic surgeon at SLUCare Physician Group, a health system in St Louis, Missouri.

"Judgment calls are what seem to be the best decision at the time, but sometimes they turn out to be wrong," he says. "There are so many gray areas in surgery. Decisions often have to be based on inadequate information."


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