I’ve been invited to participate in an academic study on an interesting concept: the medical apology. My first reaction was to decline the invitation, explaining that never once have I had a healthcare professional apologize to me when something went wrong. And I’ve had a few things go very, very wrong.
I could have used an apology at age 16, for example, when the infirmary nurse at my convent boarding school repeatedly refused my pleas to call the local doctor for my severe appendicitis symptoms, instead blaming them first on the flu, the next day on my period, and the third day on exam anxiety. I was finally hospitalized with a ruptured appendix and near-fatal peritonitis that required a month-long hospital stay. A little “I’m sorry” would have been nice. . .
But I’m thinking that some of you might have some interesting personal experiences about receiving a medical apology to share on this subject. If you’d like to get involved, here’s how to contact the researchers:
Get in touch with Dr. Fiona MacDonald directly by email at the University of the Fraser Valley. She and her team are focusing first on Canadian patients, but then expanding to patients living in the US, the UK, Australia, and New Zealand.
Dr. MacDonald explains her research project like this:
“So far, we have had interviews with patients, health authority administrators, healthcare professionals, and patient safety advocates. We’re trying to learn from as many different standpoints and perspectives as possible to get a full picture of the range of impacts that medical apologies may have for all those involved.
“We have talked to patients who received some form of apology (even if it may or may not have been at a time or in a manner that they found meaningful; we know that some apologies can cause further harm).
“And it is also important for us to learn from patients who have experienced some form of medical error or mistreatment, but did NOT receive an apology.”
These are just some of the questions on medical apologies that their research interviews will include:
Was your experience with a medical apology meaningful? If so, how?
How would you describe the impact of the apology on you and/or on your family? Did it lead to any positive outcomes? Negative outcomes?
What influence (if any) did the apology have on your thinking or feelings about the event, the medical professional or the medical institutions involved?
What, if anything, would you change about the experience?
We say “I’m sorry” routinely in everyday life, so why is apologizing such a big deal in medical practice? We know that many healthcare professionals may hesitate to apologize to patients/families when things go wrong due to a fear of legal liability.
The Canadian Medical Protection Society is a non-profit organization that supports physicians in “reducing their medical-legal risk and to contribute to improvements in the safety of patient care.” They advise their members that there are apologies, and then there are apologies.
For example, CMPS recommends an expression of regret (“I feel badly that this happened to you”) about a known risk of medical treatment or procedure, but warn that “an apology with acceptance of responsibility should NOT be provided”.
But if an outcome is related to system failures or the healthcare provider’s performance (e.g. “administering the wrong drug, operating on the wrong patient, or not acting on an important finding because of a lost lab report”), then an apology should be considered when it is appropriate to acknowledge responsibility for the harm and to apologize – but only when “determined after careful analysis”.
But, importantly, their members are generally advised:
“A statement of being sorry for the circumstances or the condition of the patient is important and appropriate. Physicians should not hesitate to express their regret or sympathy to the patient. This is not an admission of error or liability. Genuine concern by a caring physician will be appreciated by most patients and families.”
The study by Dr. MacDonald and her research partner Dr. Karine Levasseur at the University of Manitoba is being funded by grants from the University of Manitoba, The BC Law Foundation, and The Michael Smith Foundation for Health Research.
Q: How would you describe the difference between an apology that works, and one that makes things worse?