Saying sorry is hard to do

Saying sorry. Possibly one of the hardest things a doctor ever has to do.

Adverse or unanticipated outcomes can heap a great deal of strain on you personally, especially if you are worried about potential repercussions. Apologising to a patient and their family does not mean admitting legal liability, far from it. It is a natural, human reaction born out of empathy – often it feels like the right thing to do.

Here are a few things to think about before going ahead and saying you’re sorry.

The sincerity question

Feel like you weren’t at fault? You might not be the best person to apologise.

It’s more meaningful, and likely to be better received by the patient, if you give a personalised apology: “I am sorry…” is a much more human approach than an ‘off-the-peg’ response on behalf of the hospital.  

That doesn’t mean taking personal responsibility for system failures or missteps by colleagues.

But it does require actually meaning what you say: insincerity incites anger.

At a time of heightened emotions, with people often staunchly entrenched in their personal standpoint, an insincere apology can do more harm than good. Significantly more.

We’ve all received insincere apologies here and there; getting one from a doctor is going to do more harm than good. The most likely outcome being a strong detrimental effect on the provider/patient relationship, which could add fuel to an adversarial atmosphere, the sort you’d rather avoid.

Times an apology is essential 

When avoidable errors have definitely occurred, as revealed by an investigation, then that leaves little choice.

Scenarios like:

• Care given to the wrong patient
• The wrong procedure was used
• Surgery on the wrong site
• Flawed communications process
• Medication errors, e.g. wrong drug, wrong dose etc.

When a complete review of events concludes that something unexpected and preventable has happened, we recommend disclosure and apology. 

Not just as a tool to mitigate the risk of litigation, simply as it’s the right thing to do.

Are you a trained apologiser?

No one can tell you what to say or what words to choose, only you can formulate an authentic, personalised apology.

Most hospitals and healthcare organisations have policies on disclosure – their support for the provider team varies widely.

If you’ve had little or no training in disclosure, your skills in the sensitive arts of highly charged emotional conversation may not be up to scratch.

Even if you feel asking for training in saying sorry might be tempting fate, do it anyway. Knowing what to do if things go wrong can prove a source of reassurance (as can quality malpractice insurance).

Keeping the family involved

Determining whether a bad outcome was the result of negligence is difficult to do as quickly as the family would like. But keeping up relations with the family is crucial to the patient/provider relationship.

Providers should establish an honest dialogue with the patient/family, preferably with one individual who can serve as the point of contact.

Whilst keeping the family informed, focus your attention on the ongoing needs of the patient their current condition and ongoing care: when situations are tense, keep communications in the present tense.

Of course, you should highlight your commitment to keeping the family informed each and every time additional information becomes available.

Challenging relationships

Where the relationship with the family has proved challenging even prior to the outcome, doctors should not offer an apology unaccompanied.

A member of the senior leadership team is preferable, especially one experienced in difficult conversations of this nature. 

Apology essentials for patients and families

Patients (and families) expect three things. In a tone of delivery they can understand, they need to hear:

1. What happened
2. What can be done to do deal with the harm caused
3. What can be done to prevent future harm to others

Conversations should happen at such time (and place) that they are best equipped to process and retain information.

It’s important to respect privacy and dignity throughout, and provide details of who to contact for further information.

After the discussion, you should record the details of the conversation in the patients clinical record - in order to maintain consistency of any future written apology (this may be necessary in line with patients’ wishes and your workplace policy).

What if they don’t want to know the details?

Patients will usually want to know the intricacies of what went wrong. But you must ask them first, they may not want full disclosure. If this is the case, try and find out why.  If they don’t change their mind, respect their wishes as far as possible.

You should also make it clear that they can request more information at any time.

It’s important to record details of these conversations in the clinical record.

What not to say

Some defence counsel advise that ‘I’m sorry” is a poor choice of words for an apology.

The contrary argument is that it’s hard to sound authentic and sincere without it.

Nonetheless, the words you choose will send a message.  Take these two for example,

• Inadvertently
• Apparently

In a highly-charged emotional conversation, such words come pre-loaded with connotations, filling peoples’ minds with pictures of carelessness, inattentiveness and negligence.   

Tread carefully.

Sometimes bad things happen – that’s why you need malpractice insurance

Malpractice is rarely malicious – bad things can happen in spite of good care.

It’s entirely appropriate that in such scenarios you would empathise with the patient and their family. How you handle disclosure and apology can help you avert liability down the line.

Accusations and apologies may be one of the most stressful things to happen in your career – but it’s that bit less stressful when you have good quality insurance that provides 24/7 legal support and is ready to zealously defend you from the moment you tell us you’re in trouble.