Sunday, November 24, 2013

Should Doctors Apologize to Patients?

I had thought that apologizing was a straightforward act, but I now realize that it is a nuanced art form.  We’ve all heard the ‘mistakes were made’ version, usually issued by politicians who attempt to insert a layer of passive voice insulation between themselves and their screw ups.  There is also the ever present conditional apology which by definition falls short of complete responsibility acceptance.  The template here is: “I’m sorry for my oversight which wouldn’t have happened if….”

The Gettysburg Address - Silly Remarks?

There have been several apologies in the news recently.  First President Obama offered a faux mea culpa with regard to his indisputable and repeated ‘misrepresentations’ on his broken promise that we could all keep our own doctors and health insurance plans.  Here’s what he said on November 7th.

“I am sorry that they are finding themselves in this situation based on assurance they got from me.”

Finding themselves?  Really?  I grade this as beyond lame on the apology scale.

CBS’s flagship and enduring news magazine 60 Minutes apologized for using a source on a Benghazi piece who was a liar.  “We were wrong to put him on the air,” said Lara Logan a few days prior to airing a formal apology.  The latter included: “It was a mistake to include him in our report.  For that, we are very sorry.”  While some have criticized this apology as inadequate, I am more lenient here.  They admitted they screwed up, apologized and didn’t blame anyone for their mess up.  Sure, they could have fallen harder on their sword or fired a few folks, but I think they crossed the minimum standard for contrition and acceptance of responsibility.  

Recently, a newspaper issued a retraction for comments published 150 years ago.  The Patriot-News, a Pennsylvania newspaper earlier this month issued a retraction for referring to Lincoln’s Gettysburg Address as ‘silly remarks’.   Their recent editorial included the statement: “The Patriot-News regrets the error.”   I congratulate them on reaching this belated, enlightened position.  They certainly cannot be accused of a rush to judgment.  Let’s look for other retractions from them for other errant opinions they published in the 19th century.

Martin Bashir, issued 2 minute on air apology on MSNBC for a diatribe against Sarah Palin that shattered the network's already low threshold for decency and fairness.  While the apology seemed genuine, most of us would have lost our jobs for similar behavior.

What should doctors do when we make a mistake?  Of course, from a moral perspective, there is no controversy .  We should  do what we expect others to do.  When we err, we should admit it and apologize for it.  Of course, some errors are trivial and do not require us to march into the confessional.  If a patient receives liquid diet when a soft diet was ordered, the world will continue to spin.  No foul here. But substantive errors must be disclosed. 

The dilemma for physicians is fear that admission of error, which is morally required, may be used as a cudgel if the physician is sued for medical malpractice, which is an unfair arena.  Personally, I believe that this concern that apologizing will increase legal risk  is exaggerated and that a genuinely contrite physician may reduce legal vulnerability by explaining candidly what went wrong.  It should be self-evident that an adverse event or a mistake is not tantamount to medical negligence, but so many misunderstand this.  Nevertheless, physicians should choose their words carefully when disclosing medical errors to patients and their families.

Many states have physician apology laws that state that expressions of regret are not admissible in  medical malpractice trials.   These laws are narrowly crafted.  If the physician’s statement goes beyond expressions of regret and empathy, it is admissible.

 Inadmissible:   “I’m very sorry that this complication occurred and that a second surgery will be necessary."

Very Admissible:  I’m sorry that I nicked the spleen and I had to remove it.”

So, how was this post?  Verbose? Self-serving?  Tedious?  Factual errors?  Arrogant?  If so, don’t blame me.  Sometimes, mistakes are made. 


  1. I've had a couple of physicians apologize to me. If one of them hadn't moved out of the area I would still be his patient. The other 2, I'll leave when I'm dead. If they are honest enough with themselves and with me, then I can trust them with no second thoughts. I do all I can to promote them.

    I've had a couple that didn't and I'm working with the competition docs and let people know the bad times I've had with them.

    Medicine still involves trust.

  2. You sound like a very reasonable patient. If you live in the Cleveland area and need a gastroenterologist, look me up!