Apologies in Medicine
“Never apologize, mister, it’s a sign of weakness.”
Saying you’re sorry isn’t always easy. But an article recently published in CMAJ highlights an important cultural shift that is happening in medicine: a shift towards communicating medical errors to patients. Research subsequent to the seminal Institute of Medicine report “ To err is human” suggests that disclosing adverse events is a key element to disclosure practice.1 Many believe that establishing a culture of apologizing will ultimately improve patient safety.
And while we are seeing a shift in attitudes, this is not necessarily reflected in the actions of physicians. A 2007 study published in the Journal of Internal Medicine showed that while the great majority of physicians surveyed responded that they would disclose minor (97%) or major (93%) harm to a patient, only 46% had ever made such a disclosure, and 19% admitted to not disclosing a minor error. 2
Fear of legal action is cited as the main reason that physicians choose not to disclose medical errors. This begs the question: should we be separating the act of apologizing from the medical act itself? Or, as Benjamin Franklin said, “Never ruin an apology with an excuse?” The British Columbia Apology Act was passed in 2006, and is a step in this direction:
“When applied in the clinical setting, the Act prevents apologies provided by clinicians to patients and families following an adverse event from being taken into account in any determination of fault or liability and from voiding, impairing or otherwise affecting liability insurance coverage. Because the definition of “apology” includes “words or actions [that may] admit or imply an admission of fault,” the Act not only protects clinicians’ statements of sympathy or regret (“I am sorry this happened to you”) but also statements of fault (“We made a mistake, and we regret the suffering it has caused you. We are sorry”).1
For this cultural shift to gain momentum, we must also be looking at how we train the next generation of physicians. Here at Queen’s, Medical Ethics is a fundamental part of the Undergraduate curriculum. And with the recent creation of the Masters of Science in Healthcare Quality, students have an opportunity to further their studies by focusing on quality, risk and safety in medicine in an interdisciplinary two-year program.3
Whether the disclosure of error is separated from the apology itself, one thing is true. Apologies make the person who was wronged feel better. This simple yet powerful action can earn trust, strengthen relationships and build character: all important qualities for patient-centered care.
If you have any thoughts on apologies in medicine, please comment on the blog, or better yet…please drop by the Macklem House, my door is always open.
My thanks to Jen Valberg, our Communications Coordinator, for her help in preparing this blog.