By Christopher Cheney
There are best practices to follow when physicians make apologies to patients, an expert on clinician-patient communication says.
Trust is an essential component in the relationship between physicians and patients. When a medical error occurs or a physician creates a negative patient experience such as being significantly late for an appointment, an apology can repair damage to the trust in a relationship.
“I cannot think of a circumstance when a physician has created a situation that requires an apology and should not make one. Erring on the side of making the apology is better than remaining silent or not making an apology,” says Richard Frankel, PhD, a professor of medicine at Indiana University School of Medicine and research scientist at the Indianapolis-based medical school’s Regenstrief Institute.
There are four elements of a complete and genuine apology, says Frankel, who co-authored an award-winning journal article on physician apologies last year.
- Acknowledgment of a problem
- Explanation of why the problem occurred
- Expressing sincere remorse or regret
- Some form of recompense that could be financial, psychological, and/or a commitment to change behavior
“A genuine apology incorporates all four of those elements. The best practice is to engage in all four elements,” he says.
Going beyond acknowledgment and explanation is crucial to make a genuine apology, Frankel says. “A key element is sincere remorse—’I am sorry for what I did, I recognize what I did, I take responsibility for what I did, I am remorseful, and I want to do better.’ The restoration of the relationship will often hinge upon making a commitment. It is committing to doing something differently rather than simply offering a mechanical response in the moment, then moving on to the next thing.”
Incomplete apologies often have a negative impact on the physician-patient relationship, he says. “People do not trust a partial apology, and they do not feel it is sincere when what they want is a sincere expression of the other person’s remorse and sincere expression of what they are going to do about it. A partial apology comes across as being untrustworthy, and trust is a huge part of what a genuine apology restores.”
It is possible to measure the impact of apologies, Frankel says.
“The impact of apologies can be measured both directly and indirectly. Directly, when apologies occur, the rates of medical malpractice lawsuits decline. The indirect measures are things like physician resilience. Where apology does not occur, the rates of depression for physicians are greater and the rates of suicide are greater.”
Apologies, malpractice litigation risk, and physician well-being
Clinicians should not avoid making apologies out of fear that apologizing to a patient will increase the odds of drawing a malpractice lawsuit, Frankel says. “The evidence is that where apologies are made the risk of malpractice lawsuits goes down. In 17 states there are laws that shield a physician from being sued for medical malpractice if they offer an apology. There is a growing recognition that apology is a good preventative for medical malpractice lawsuits.”
Apologizing to patients also boosts physician well-being, he says.
“There is also research that shows that physicians who make medical errors suffer themselves disproportionately to the medical errors that they make. Like anyone who is in a skilled profession or a skilled trade, when you make a mistake, it is harmful to the other person, but it is also harmful to the professional or tradesman. It harmful to your sense of pride. It is harmful to your sense of being able to practice at a level of skill that you thought you had. Apology is one way to restore confidence and one way to restore the balance between your skills and your psychological well-being.”
From the clinician’s perspective, Frankel has seen the healing potential of apologizes many times. “I know from personal experience of working with hundreds of physicians that the act of making an apology—though it can sometimes be difficult and painful—almost always results in a relief of distress.”
Apologies and medical errors
Making a complete and genuine apology is appropriate when a medical error has occurred, Frankel says.
“For example, a physician might say, ‘We gave you the wrong medication. Fortunately, it is not a medication that is going to cause you any harm, but we take this kind of situation very seriously. We acknowledge that we made a mistake; and when this happens, we want to learn from our mistakes and learn to do a better job. We are sincerely sorry and remorseful that this occurred, and we are dedicated to making it right for you and making it right for anybody who comes after you.'”
Christopher Cheney is the senior clinical care editor at HealthLeaders.