Jan-Feb 2010 Table of Contents

THE LAST WORD

The Power of Apology



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When a patient suffers from a medical mistake, two words can usher in healing.

Fam Pract Manag. 2010 Jan-Feb;17(1):40.

I felt awful. I didn't know if there was any way I could have known or anything I realistically could have done, but part of me blamed myself. My patient was suffering and, at least in my mind, I may have contributed to it.

After a brutal day at the office with a packed patient schedule, I had one more difficult stop to make before going home. I had to go tell a person whose family had entrusted me to be their doctor that “I'm sorry.”

At least 29 states have enacted what are commonly known as “apology laws.” While some variance exists state to state, the idea is that a physician can express remorse to a patient without that act being an admissible piece of evidence in a malpractice trial because the act of apology is not admission or assignment of fault.

The American Medical Association Code of Ethics states that a physician is required to disclose to a patient when a mistake is made. In practice, however, this often does not take place. While the threat of malpractice and the collective “white coat of silence” are partially to blame, I think the real reason we are slow to disclose errors is much more personal. Apologies expose our personal vulnerabilities and serve as open reminders of what we all know to be true: We make mistakes.

The Sorry Works! Coalition is an advocacy group for disclosure and apology laws that offers training for physicians. Their curriculum is based on a three-step process of 1) initial disclosure, 2) investigation and 3) resolution. I decided to start with step one and see how things went.

Walking up to the hospital room, I rehearsed in the stairwell what I was going to say. “I'm sorry.” “I want to apologize.” “This is indeed unfortunate what has happened.” Where was the right balance between sincere apology and excessive self-blame? How would this patient and the family react? Would they kick me out of the room and open up the yellow pages to find the closest malpractice attorney? Maybe.

I remembered reading an article on apologies1 that outlined the steps I should be following and the people I should have notified, but I didn't feel that I had time for that. I had this sense of urgency that, even though it was far from clear that anyone was at fault, I needed to do the right thing, and I needed to do it that night before I went home and faced my kids. How many times had I told them the importance of saying, “I'm sorry”? Despite the risk of having my apology blow up in my face, I kept coming back to the fact that this was the right thing to do for my patient, the family and for myself. If they needed to blame me for what happened, so be it.

Standing outside the room I reviewed my plan one last time and took a deep breath before entering. And then I said, “I'm so, so, so sorry this happened to you. ...”

We spent the next hour talking about what had taken place and what other doctors had told them about the case. We all agreed it was as complex as it was tragic. As I got up to leave, one of the family members asked, “You'll still be our doctor, won't you? We love you. You are our friend.”

A weight had been lifted, and I could feel the tension leave my neck and shoulders. While this family's kind and generous expression certainly helped, the real benefit came from the humble act of doing the right thing.

About the Author

Dr. Cohen is a private practice family physician and adjunct faculty member at St. Peter Family Medicine Residency in Olympia, Wash. Author disclosure: nothing to disclose.

Send comments to fpmedit@aafp.org.

1. Roberts RG. The art of apology: when and how to seek forgiveness. Fam Pract Manag. July/August 2007:44–48; http://www.aafp.org/fpm/2007/0700/p44.

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