Tuesday, November 24, 2009

Is it Risky for a Doctor to Say, "I'm sorry"?

The movement for physicians to say "I'm sorry" when things go wrong in patient care has been under debate for the past few years. In the past, physicians were advised to never admit to a problem or to apologize for clinical errors with the thought that it would lead to more lawsuits. Saying "I'm sorry" might be taken by a lawyer as an admission of guilt and malpractice. Attorneys advised, "Say nothing" but that left patients with unanswered questions and often the feeling that the doctor just didn't care.

Numerous studies have shown that patients want physicians to disclose harmful errors and they want information about what happened, why it happened and if something has been done to keep it from happening again. There has been a gap between what patients want and what actually occurs.

Physicians are not trained to disclose mistakes and being stoic is rewarded more than empathy in medical training. Many lawsuits are filed against doctors because of anger so the silent approach that physicians have taken may actually be backfiring.

There is a group called "Sorry Works" that teaches doctors and nurses to be empathetic, caring and stay connected with patients and families when an adverse event occurs. The honest approach reduces anger and blame and often removes the urge to pursue litigation.

Thirty-five states have passed apology immunity laws that say "sorry" cannot be used as evidence of wrong doing.

There is certainly no way anyone can prevent a lawsuit. Saying "I'm sorry", without admitting guilt should be in the doctors professional code of ethics and behavior.


Anonymous said...

This is a very important topic to bring up and interesting for all the points you make.
I was in a waiting room when a patient told the doctor her husband had died a few days before, thinking the physician had known, but clearly didn't. "The physician said I knew it was going to happen", but didn't say I'm sorry. The interaction bothered me because it felt like a lack of sympathy and compassion that was not shown as being felt in a human way for her loss.

Michael Kirsch, M.D. said...

This is tricky stuff. The 'apology laws' don't provide legal immunity for falling on your sword. An apology is not admissible, but an admission of wrongdoing is. In other words,

"I'm sorry this happened to you" would be protected.

"I'm sorry that I left a monkey wrench in your abdomen" is fair game.

I recently removed a large colon polyp and the nurse discarded the specimen. Here's how I handled the situation. http://bit.ly/7L06r4
Of course, it helps when you have good rapport with the patient and the family.

tracy said...

My dad's cancer doctor actually apologized to him for giving him too much radiation, which lowered his blood counts (and immunity) so badly he ended up in the hospital and almost died. According to my mom, he is NOT the type of doctor to e v e r say "I'm sorry" . Ummmmm, trying to avoid a lawsuit, perhaps?

Toni Brayer MD said...

tracy: Maybe he was really sorry.

MichaelKirsch: I tried to comment on your site without luck. You handled it really well. I hope you take the lead in your hospital to make sure processes are in place so it never happens again. I thought all specimens were sent to path automatically. Optional brings in the human element and errors.

Amanda said...

This is a very interesting topic......my question is why are we taking the ultimate career in humanity and expecting it to be dehumanized? Patients have to realize they are putting their trust in the hands of people, albeit people with a PhD in medicine. Mistakes are absolutely a symptom of humanity and to advise a doctor NOT to say "I'm sorry" completely dehumanizes the medical profession.

Jen said...

Tricky question, from what I understand about U.S. malpractice laws. I've had 2 doctors apologize to me in Canada- one, for assuming that my daughter had stomach flu rather than symptoms from her cancer (duh...how often does anyone run a full workup on an 8 year old who's throwing up?), and one from our family doctor who'd missed my mom's initial skin cancer, which ended up killing her years later.

I can't see any way that the first doctor could be held culpable, but I would imagine that if we'd been inclined to sue the second in the U.S. we probably could have gotten something. Did it suck that my mom ended up dying from something that probably could have been taken care of early? No doubt at all. But doctors are also human, and can't possibly catch everything that comes across their plate in a day. Having him apologize to us at the funeral home (when he'd been retired for over 10 years) meant a lot, and I have a lot of respect for him for doing it.

But even with that respect, I'm not sure that if we'd ended up with a hospital bill in the hundreds of thousands of dollars (which after 9 surgeries, chemo/radiation, and months of hospice at the end I'm sure that we would have), that we wouldn't have viewed his apology in a different light. I hope that apology immunity laws become the standard.

Toni Brayer MD said...

Jen: Interesting point of view. One has to wonder if the exorbitant cost of health care in the US might drive malpractice suits.

Amanda: Amen

Jonathan said...

It is important to note that when mistakes in health care arise, they generally have little or no effect on the patient whatsoever. Indeed, even though avenues of increased communication and disclosure between Doctor and patient have been forged in recent years, mot patients won't even be aware that a mistake has occurred. The other side of the coin can equate to deliberate harm and these thankfully rare occurrences have been well documented in a series of high profile cases. The ground in between these two opposing ends of a complicated spectrum arises from incidents where Doctors looking after a patient essentially failed to do their very best. From the perspective of a Doctor, the reasons behind mistakes can be easily explained. Anyone can make a mistake particularly when working under pressure. Although gross negligence is totally indefensible, it is also worth remembering that medical ailments don't always follow the textbook example. Do visit us at Medical Negligence Solicitors.

viagra online said...

The mistakes can happend everytime, everywhere and the think about say I'm sorry, depende on everyone and admit it if you scrub up, by the way in legal terms it's different, if you say it you surely going to jail because you are admiting you do something wrong clearly, so mostly deppends of the kind of person.

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It won't actually have success, I consider this way.

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