Should you apologize (MEDICAL ECONOMICS SPECIAL SECTION)

April 1, 2007

Tempted to tell patients when you've made an error but afraid that too much honesty isn't the best policy? Here's how to do it safely.

Key Points

In December 2003, 13 months before she died of liver cancer, the journalist and essayist Marjorie Williams wrote a column for TheWashington Post about why she felt uneasy about Howard Dean's presidential bid. Her chief complaint: "The man is a doctor. . . . Where else but in medicine do you find men and women who never admit a mistake? Who talk more than they listen and feel entitled to withhold crucial information?"

Williams' cynical take on the medical profession-the result of a long illness during which she saw dozens of physicians and medical students in several different settings-is unfortunately shared by many people. The problem is compounded by the fact that even physicians who are inclined to acknowledge mistakes and discuss adverse medical events with patients are discouraged from doing so, most often by malpractice insurers. But insurers, hospital administrators, educators, and other major players in the medical profession are starting to notice that the words "I'm sorry" can mollify angry patients-and might increase the likelihood that an injured patient will settle out of court, or not sue at all.

Clear data has yet to emerge on whether disclosure of medical errors saves doctors and insurers money, but from an ethical standpoint, many experts say honesty is the best policy. "It's consistent with our commitment to medicine and with the oath we took when we entered the medical profession," says pediatrician Gerald B. Hickson, associate dean for clinical affairs and director of the Center for Patient & Professional Advocacy at Vanderbilt Medical Center in Nashville.

What to say-and not say-when something goes wrong

"As a rule, a physician who's aware that he has made an error should relay that information to the patient," says attorney Martin J. Hatlie, founder of the Chicago-based Partnership for Patient Safety. But not all bad medical outcomes are the result of a mistake: the problem might be a normal sequela of the underlying illness, or another factor. So, initially, Hatlie notes, "That might mean saying, 'I don't know why this happened. I'm going to investigate it and get back to you as soon as I know more.' "

"It's important to review what you'll say and to have answers to questions you can predict," says FP Sarah P. Towne, assistant dean of clinical education at Touro College of Osteopathic Medicine in Vallejo, Calif. "Charging in without doing your homework is ill-advised and might leave everyone feeling worse." Additionally, as with most sensitive conversations, the "how you say it" factor is crucial. Experts recommend the following: