Neil Baum, MD
Most fairy tales begin with “once upon a time.” There is a fairy tale in the healthcare profession: once upon a time the initials “M.D.” indicated status, trust, and perfection. Most physicians today realize that elevated status, abundance of knowledge, infallibility, and blind trust by our patients are long gone and are the stuff of fairy tales.
Patient experience and patient satisfaction have emerged as critical criteria in a patient-centered healthcare environment. We believe that the Internet has leveled the playing field of knowledge between patients and physicians. The media has highlighted the errors and mistakes, as well, and have hung out our dirty laundry for all to see. Then there is the Institute of Medicine’s study in 1999, which chronicled nearly 100,000 deaths as a result of medical errors.
And certainly we can’t overlook the legal profession that is constantly at our heels threatening to litigate against us when the outcome is less than perfect.
So what can we do?
We can continue to assume a policy of deny and defend the situation when there is an undesirable outcome. Or perhaps, we can adopt a policy that is more human and natural, i.e., an apology.
For this article, we have interviewed Dr. Michael Woods, a surgeon and author of Healing Words-the Power of Apology in Medicine. Perhaps after reading this article you will understand that we are not perfect, and that perhaps an apology will do a great deal to assuage a patient having the knee jerk reaction of considering litigation when things don’t always go as planned.
This article will cover the benefits of offering an apology when things go awry and the techniques of apologizing without admitting guilt.
“I’m sorry” is one of the most commonly used phrases in any language. Most of us don’t think twice about offering an apology when we unintentionally bump into a stranger on the sidewalk. However, when we have made a mistake, and nearly every one of us has during our medical career, the words seem to get stuck in our throats and just won’t come out easily.
Why the difficulty? According to Dr. Woods, we begin learning detachment the moment we begin our medical training. This is compounded by the fact that with declining reimbursements and increasing overhead costs, we need to see more patients in less time and we are often wary of engaging our patients in honest, open dialogue.
In addition, our malpractice insurers tell us that an apology might be interpreted as an admission of fault or negligence that could expose us to litigation. There are even some insurers that will void our malpractice policy if a doctor apologizes to a patient in the wake of a complication or error.
Why do patients sue their physicians?
Dr. Woods points out that numerous studies show an inverse relationship between being sued and communications skills or that the likelihood of being sued is significantly decreased as communication skills are increased. Those with the best communication skills ask the patients more questions, encourage patients to talk about their feelings, use humor when appropriate, and educate patients about what to expect during their treatment.
Those with enhanced communication skills spend a few more minutes with their patients, about three minutes per visit, than those physicians who have been sued. Another fact worth noting is that the likelihood of a lawsuit decreases by 50 percent when an apology is offered and the details of the medical error are disclosed in a timely fashion.
How can we effectively apologize without admitting guilt or wrongdoing? Dr. Woods suggests that an authentic apology is one that is heart-felt and driven by true regret or remorse. According to Dr. Woods there are five reasons to apologize:
- Show the patient you respect them
- Show you are taking responsibility for the situation
- Demonstrate you care about the way the patient feels
- Demonstrate your empathy
- An apology results in dissipating anger and disarms the individual
Patients want to know what happened and why it happened, how the problem or error will affect their health in the short and long term, what is being done to correct the problem, who will be responsible for the cost of the error or complication, what has been learned and what the doctor is doing to avoid this happening again.
Planning your apology
Dr. Woods cautions that a poorly planned apology can be as bad as or worse than no apology at all. Begin by admitting to yourself what has happened to the patient. Next, think about the ramifications of your actions or inactions leading to or causing the problem. Certainly look at the situation from the patient’s point of view and try to understand his/her feelings.
This is easy to do if you trade places with the patient and imagine how you would feel if you were in their situation. It is also important to forgive yourself for any causal role you had in the incident. And finally, plan and prepare your apology. This may even mean writing out what you intend to say, how you want to say it, and when you should say it.
Dr. Woods advises four “R’s” of an authentic apology. First is RECOGNITION. We must be able to read our own feelings as well as the feelings of the patient and their families. If you feel regret or remorse, it is a good indicator that an apology is in order. If the patient is interacting with you differently or is reluctant to talk, it may be an indicator that there are unmet expectations or you are not meeting their needs adequately.
Next is an expression of REGRET. By expressing regret, you are demonstrating an empathetic response that lets the patient know you understand their situation and that you feel badly about it. Empathic expressions such as “I am so sorry; I know this outcome is not what you expected, it is not what I expected either,” does not admit your guilt but does allow the healing of the relationship to begin.
Third is RESPONSIBILITY and an honest and forthright explanation of what happened, why it happened, how it will affect short and long-term health status, and what steps are being done to protect others from the same untoward result. It is our responsibility to provide all of this information.
The final “R” is REMEDY or what is being done to correct the problem that the patient is experiencing. Included in the remedy is the issue of cost and who will bear the price of remedying the problem.
Bottom Line: Perhaps when we are comfortable with the words “I’m sorry” and can say them easily and with sincerity, we can expect better healthcare, increased job satisfaction, and lower malpractice premiums.
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Dr. Neil Baum is a nationally recognized urologist, speaker, and author. He has been in the private practice of urology in New Orleans, LA, since 1978 and is Associate Clinical Professor of Urology at Tulane Medical School and Louisiana State University Medical School, both in New Orleans, LA. He is the author of Marketing Your Clinical Practice—Ethically, Effectively, and Economically (Jones and Bartless, 2009, 4th edition). This post was adapted from an article that appeared in ModernMedicine, and is used with the permission of the author.
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