The responsibility to act with civility applies to all of us, all the time, whether physician, nurse practitioner, physician assistant, or transport assistant. Apology and truth-telling — basically, acting civil — should be a requirement of everyone in the health-care industry.
Developing your apology begins with paying attention to those situations of the least infraction — incidents or actions that would typically result in an apology outside of medicine. Do you apologize to your loved ones if you’re late? Of course you do. Do you apologize to your patients and their families for running behind in clinic? Maybe yes, maybe no. But the answer should always be “Yes.”
If you apologize for the little violations of trust — being late, interrupting, or forgetting to call the lab — it will be much easier to apologize for the larger ones, such as ordering the wrong medication, test, or procedure. You will have established the trust required to apologize with conviction, without worrying that you’ll be perceived as insincere and trying to manipulate the relationship.
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For providers, liability concerns are the biggest barrier to saying “I’m sorry.” But studies have shown that an apology from a health-care provider may lead to fewer legal consequences, not more. For example, one frequently cited study of 149 patients in an academic, general internal medicine outpatient clinic revealed that nearly all (98%) of the subjects wanted some acknowledgment of even minor errors. Moreover, they were significantly more likely to consider litigation if the clinician didn’t disclose the error (Arch Intern Med. 1996;156:2565-2569). An earlier study found that patients’ decisions to take legal action were based not only on the injury itself, but also on insensitive handling and poor communication following the injury (Lancet. 1994;343:1609-1613).
In the ensuing years, policies encouraging clinicians to disclose and apologize for mistakes led to a reduction in the number and cost of malpractice claims (JAMA. 2006;296:1401-1404). Apology is not an admission of guilt. Rather, apology is about respectful empathy.
A huge misconception of providers is that malpractice liability is driven by ambulance-chasing attorneys and patients who want to spin the wheel of fortune. This idea relieves us of responsibility for our own liability — after all, we can’t control someone’s willingness to sue. Or can we? Many patients sue because they’re angry with their provider, feel they haven’t been dealt with honestly, and feel information has not been freely shared. The practice of apology and truth-telling eliminates these issues as drivers of litigation. Consider that in a review of 154 patients who sought corrective action following medical injury, 40% said they wanted more satisfying communication with the provider. In many cases, an explanation and/or an apology—not compensation—was all the complainant was after (CMAJ. 2006;175:889-894).
There may be a temptation to use apology and truth-telling as a risk-management strategy, but patients are very perceptive to changes in the way they’re being treated. If you haven’t established trust by offering apologies for minor daily infractions, then serving one up after a severe outcome — only because you know it may lower your liability — could well anger the patient.
Apologies offered for the right reason, at the right time, and in the right way instill trust in your relationships and result in better patient satisfaction and outcomes. Lower, not higher, liability will follow the clinician who acts civilly.
