Medical errors, disclosure, and the role of apology: a tool for ... - TMLT

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When do you Apologize Since childhood, most of us have been taught that when you do something wrong, you apologize. We certainly expect an apology from those whose fault causes us to suffer a loss because it is considered the right thing to do. Webster’s International Dictionary defines apology as “an admission of error or discourtesy accompanied by an expression of regret,” and further states that it usually carries an “…implied admission of guilt or fault.” Accordingly, even if a doctor does not believe that he is guilty of an error, apologizing for the outcome may be misconstrued. Hopefully this discussion will assist physicians in distinguishing between situations requiring empathy, compassion, and concern from those infrequent situations in which a true apology is warranted. Information is also provided to assist in the process of effectively communicating with patients in both situations. The use of the term “true apology” in this pamphlet means admitting that an error occurred and expressing regret. Apology, in this situation, implies an admission of guilt or fault. Why is this Important What purpose is served by expressing your remorse to a patient over a bad outcome or untoward incident Although this brochure is not intended to outline the moral obligations inherent to your profession, there certainly is an ethical component to this issue. At the end of the day, you need to know you’ve done the right thing. Your conscience may not give you peace of mind if you fail to heed the inner voice that wants you to express your feelings of concern. When an apology is truly warranted, accepting and expressing responsibility for your mistakes is the first step to forgiving yourself and is the most likely way to maintain a good relationship with your patient. Demonstrating true sadness to your patient for his pain will help him and will strengthen the bond between physician and patient. It is important for patients to feel that doctors care about them. Patients who have good relationships with their physicians will more likely forgive them in the event of an adverse outcome. Additionally, studies show that claims may be avoided by developing a good relationship with patients.
Juries have forgiven physicians when they believed the physicians tried their hardest, cared about their patients, and were honest when explaining the events. For example, in a trial where the jury returned a verdict in favor of the physician, one juror reported that he believed the doctor may have made a mistake but also felt the physician had done his best for the patient. On the other hand, juries tend to be harsh with physicians who appear to be uncaring and uncompassionate. When something potentially bad has happened to a patient and he knows it, he wants answers. You certainly would if the roles were reversed. Any seasoned plaintiff’s attorney will tell you that evasive or defensive responses by a physician are primary factors in “morphing” patients into plaintiffs. By the same token, those same attorneys can tell you stories in which the patient wanted to sue other doctors but didn’t want his attorney to sue the one doctor he felt was forthright, honest and compassionate about the incident. Although a sincere apology or expression of concern may not avoid a lawsuit, the failure to do so when indicated can certainly trigger one. When is a True Apology Warranted True apologies are certainly warranted when clear medical errors have occurred. For example, if a surgeon removes the wrong kidney in a patient, leaving the diseased kidney in place, the surgeon should promptly and appropriately communicate the error and apologize. Fortunately, these situations are very rare. There are other circumstances in which the surgeon may feel responsible for the outcome. However, such an outcome could have occurred even if the physician met the standard of care. For example, a patient with multiple back surgeries could undergo spinal surgery performed at the wrong level because of a distorted anatomy. Sometimes patients’ medical conditions are so complex that the actual causes of the injuries are unknown until much later, if ever. In those situations, true apology is not warranted. However, discussion about the event, expressions of empathy and concern by the physician are very important. In other situations, an error may have occurred, but it may be unrelated to a particular adverse outcome. For example, a patient may have received the wrong dose of a medication. However, it may not be the direct cause of the injury. It is important for the patient to receive appropriate explanations regarding the injury. The physician should be involved in discussions to determine the cause and outline measures to resolve any problems. Likewise, the physician should express empathy and compassion regarding the situation.
Page 1 and 2: Medical Errors, Disclosure and the
Page 3: Preface In recent years, health car
Page 7 and 8: Recordings: You should not record y
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Page 11 and 12: Resources Healthgrades. Healthgrade

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