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

Leigh Page

Disclosures

July 17, 2019

"Leave it up to your natural instincts," he says. "Think about when someone apologized to you. What was it about the apology that made it feel sincere and authentic?"

Gallagher says doctors need to reach out to patients immediately after an adverse event occurred. "If you wait for them to ask about what happened, they will already be distrustful," he says. "When that happens, there's nothing you can say to help them be less distrustful."

Even though it may be too early to know what happened, let patients know what you know. "Let them know something unexpected has happened, and tell them what the process will be like to determine what happened going forward," Gallagher says.

Someone should make an expression of regret to the patient and family, but it should not be an admission of fault this early on.

Don't jump to conclusions. "Someone should make an expression of regret to the patient and family, but it should not be an admission of fault this early on," adds Gallagher.

Later, the doctor or other decision-maker at the CRP has to decide whether an apology is needed, and that can simply be a judgment call, says Hickson. "Studies have shown that in many circumstances, experts cannot agree on whether or not a bad outcome was caused by an error," he says.

In most cases, however, no one is to blame for the adverse outcome. Gallagher estimates that 75%-80% of adverse events are not due to error.

Patients need a full explanation of what happened, Gallagher says. "The harm event might have been mentioned as a possible outcome in the informed consent process before surgery, but you can't just say, 'We already discussed this possibility in the informed consent process,'" he says. "You have to fully describe what happened."

Patients also want to know what the organization will do to prevent the error from happening again, Gallagher explains. This shows the seriousness of the apology. "For example, when there is a delayed diagnosis due to failure to deal with a critical test result, there are some things a provider could be doing differently," he says. "Could something be done with the electronic health record or with staff assignments?"

Doctors in large organizations get training on these techniques through the organization's CRP. Independent doctors can get training through publicly accessible modules, such as the Communication and Optimal Resolution (CANDOR) Toolkit, developed by the Agency for Healthcare Research and Quality.[16]

Conclusion

Apologizing to a patient for an error can help put the doctor-patient relationship back on track after an error is made.

Most patients want an apology. Also, the profession's own ethical guidance, such as the AMA Code of Medical Ethics, instruct that disclosing errors is the right thing to do.

However, apologies are still risky for doctors. Even when patients are touched by the apology, they may still sue, and most state apology laws—despite their name—do not protect a physician making an apology from such lawsuits.

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