Most fairly tales begin with “once upon a time.” There’s another fairy tale in the health care profession that once upon a time the initials “M.D.” after your name indicated status, trust and perfection. Most physicians appreciate that elevated status, infallibility and blind trust by our patients in their physicians are long gone and are the stuff of fairy tales.

We believe that the Internet has leveled the playing field of knowledge between patients and physicians. Also, the media have highlighted the errors and mistakes 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/year as a result of medical errors.¹ Certainly, we can’t overlook the legal profession that is constantly nipping at our heels threatening to litigate against us when the outcome is less than perfect.

What can we do? We can continue to assume a policy to deny and defend the situation when there is an undesirable outcome. Or perhaps we can adopt a policy that is more human and natural–an apology.

Perhaps after reading this article you will understand that we are not perfect nor are all of our diagnoses, treatments and recommendations. Perhaps an apology will mollify a patient having the knee-jerk reaction of considering litigation when things don’t turn out as planned.

“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 medical mistake–and nearly every one of us has during our medical careers–the words seem to get stuck in our throats and become difficult or impossible to express.

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 have less time to spend with patients, and we are often wary of engaging our patients in honest, open dialogue. In addition, often times our malpractice insurers tell us that an apology might be interpreted as an admission of fault or negligence that could make a defense difficult if the patient proceeds with lawsuit.

The likelihood of being sued is significantly decreased as communication skills are increased. Those physicians 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 treatment. Those with enhanced communication skills spend just a few more minutes with their patients–about 3 minutes per visit–than those physicians who have been sued. Another fact that is worth noting is that the likelihood of a lawsuit decreases by 50% 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?

An authentic apology is one that is heart-felt and driven by true regret or remorse. There are 5 reasons to consider an apology:

1. It shows the patients you respect them.
2. It shows you are taking responsibility for the situation.
3. It demonstrates you care about the way the patient feels.
4. It demonstrates your empathy.
5. It results in dissipating anger.

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, and finally what has been learned and what the doctor is doing to avoid this happening again.

Bottom Line: The take home message: Perhaps when we are comfortable with the words “I’m sorry” and can say them easily and with sincerity, we can expect better health care, increased job satisfaction and lower malpractice premiums.