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

Leigh Page

Disclosures

July 17, 2019

"This was the only evidence that there had been a perforation," he said. However, the family could not find an attorney to take the case, and they could never get to the bottom of what really happened.

Suspicions that doctors are not telling the full truth are a common reason for filing a malpractice lawsuit. A groundbreaking study in JAMA found that the number of people who filed malpractice claims because they doubted a physician's honesty was the same as those who filed because they wanted some kind of remuneration.[11]

Although some doctors may stonewall, patients and families desperately want an explanation for adverse events. In a 1994 study, a sizeable number of malpractice litigants said they might not have sued their physician if they had received an apology and explanation.[12]

Apology Programs That Work

If apologizing has such a profound effect on patients, why wasn't that conclusion borne out in the Stanford Law Review study on the impact of apology laws?

In fact, the authors of that study did note that apologizing did seem to be successful in one venue—disclosure programs at hospitals called communication and resolution programs (CRPs).

The authors noted that after a CRP was introduced at the UMMC, demands for compensation fell by about one third, and the number of lawsuits fell by about two thirds. The hospital saved almost 60% in compensation costs, allowing lawsuit costs to drop by nearly 45%.

Although physicians in general struggle with apologizing, the authors noted that physicians in UMMC's CRP and other successful programs "likely benefitted from being trained on when to apologize and what to say when apologizing."

Physicians and others involved in an adverse event learn to present the event in a way that resonates with the patient, experts familiar with the programs say. They also coordinate their views on what happened, so as to provide a unified narrative for patients.

Another key element of the CRP process is providing a payment to the patient or family. Patients can respond positively to an apology but still sue because they seek compensation. The CRP payments are acceptable to them even though they tend to be much smaller than typical awards in lawsuits.

Many hospitals, especially teaching hospitals, have launched CRPs. Although two of the authors of the Stanford Law Review article teach at Vanderbilt University Law School, Vanderbilt's medical center hosts one of the first CRPs, the Center for Patient and Professional Advocacy. The center, in turn, partners with more than 170 healthcare organizations across the country to help them launch and operate their own CRPs.[13]

CRPs involve several activities, including apologizing, so it's hard to show how much of an effect apologies alone have in reducing lawsuits, says Gerald B. Hickson, MD, senior vice president of quality, safety and risk prevention at Vanderbilt University Medical Center and a cofounder of the CRP.

I do believe an apology has a role in reducing malpractice lawsuits, but it's hard to tease out the effect of an apology.

"I do believe an apology has a role in reducing malpractice lawsuits, but it's hard to tease out the effect of an apology," Hickson says.

Do Hospital CRPs Manipulate Patients?

Although CRPs may be effective, critics such as Cotton suspect them of manipulating patients with controlled narratives and money offers.

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