Medical apologies

‘Deny and defend’ a wrong tactic for medical errors

Despite this basic psychology, ‘deny and defend’ has been the traditional mantra of malpractice lawyers and insurance companies. US studies have shown that only about 30% of medical errors have been disclosed to patients in the past. There is no evidence that being honest with patients makes it more likely a doctor will be sued, according to Dr. Lucian Leape from the Harvard School of Public Health, who is an internationally recognized leader of the patient safety movement. In fact, he said, most evidence points to the opposite.

“When you are honest, and inform patients, and apologize and make some effort at restitution, the actual number of suits drops dramatically and the total amount of payouts drop dramatically. That is, you pay much smaller amounts to compensate people for the injury – the kind of payments most of us think [are] totally appropriate. I don’t think patients should have to sue us in order to have us pay for an injury that we caused.”

Disclosing errors is better than hiding them

An honest and heartfelt apology can go a long way to alleviate patient anger and dissatisfaction, and perhaps even prevent—rather than hasten—any legal action. Dr Leape advises: “To apologize effectively to a patient for a medical error, first find out exactly what happened. Get the facts. Don’t simply react with emotion or guilt. If an apology is, indeed, warranted, make sure that it is sincere. Acknowledge the error, give the patient an explanation of what happened, express remorse that it happened, and outline what steps you will take to make reparation.”

Further tips for making a medical-related apology effective
  1. Ideally, the apology should be made face-to-face, even though this feels awkward. Patients respect the fact that this effort was made in the interests of goodwill and accountability.
  2. Arrange the meeting venue to be a comfortable and private place. Also, consider who should be present during the apology. Should it be simply the healthcare provider who made the mistake, or the department chief? Should the patient’s family be present?
  3. Ask the patient about their understanding of what happened. This will give insight into how they interpreted the situation, what they know, and what they don’t know. Ask them to list their concerns, how they have been impacted, any questions they may have, and any needs that haven’t been met.
  4. Present a simple, chronological timeline of the facts and the reasons behind what interventions were used, and which were not.
  5. Avoid angry rebuttals and defensive statements that may relay insincerity to the patient during an apology.
  6. Be prepared to discuss a fair offer of compensation with patients in whom an actual injury has occurred. Start by communicating the understanding that no amount of money can compensate for the harm or loss the patient or their family may have experienced, as well as the hope that it may, to some extent, ease some of their burden. Remember that financial compensation may be also be required for medical errors that do not cause harm.
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