The medical apology: have you ever received one?

~ Carolyn Thomas

by Carolyn Thomas  ♥  @HeartSisters   ♥  August 26, 2018

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:

  1. Was your experience with a medical apology meaningful? If so, how?

  2. 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?

  3. What influence (if any) did the apology have on your thinking or feelings about the event, the medical professional or the medical institutions involved?

  4. 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?

See also:

Why is it so hard for your doctor to apologize?

The heart patient’s chronic lament: “Excuse me. I’m sorry. I don’t mean to be a bother…”

Cardiac care for the whole patient – not just the heart

Two big factors that can impact a patient’s loss of ‘self’

Just not listening – or “narrative incompetence”?

Same heart attack, same misdiagnosis – but one big difference

How implicit bias in medicine hurts women and minorities

Published by Carolyn Thomas

14 thoughts on “The medical apology: have you ever received one?”

  1. I would like an apology from the obstetrician in charge of my 4th cesarean delivery, for which I had an epidural. I was awake so I heard everything that was said. There was an inexperienced resident who was doing the work under the verbal guidance of the OB.
    I listened to the OB’s direction to carefully cut through adhesions in my low abdomen from the previous surgeries. I could hear the OB saying the scalpel was at too much of an angle up. Then saying if the cutting angle didn’t change, the resident was going to cut into blue sky. The resident proceeded to do just that, cutting right through my skin in an unplanned spot.
    For the last 32 years I have had a scar, about 3
    inches below my navel, slightly to my right. Because (predictably) I formed new adhesions, that little scar is fixed to bowel or bladder, indented like another navel.
    I knew I was in a teaching hospital so residents are learning their skills. I fault the OB for allowing the procedure to continue when the bad outcome could have been prevented.
    An apology from the 2 doctors who left me with an unnecessary, odd-looking extra scar would have been much appreciated.

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    1. Thanks for sharing that incident, Jenn. Jeeez Louise… Teaching hospitals are in a league of their own, aren’t they? All patients know upfront that there will be students observing and practicing under a senior doc’s supervision, but when the student is clearly NOT FOLLOWING the supervising physician’s instruction, it’s time to immediately step in so the student can spend more time observing and less time inappropriately wielding a scalpel on helpless patients.

      By comparison, I had a haircut incident many years ago when I was getting a reduced-cost cut in a salon school (reduced cost because student hair stylists could practice on clients before graduating). I finally asked my student to call her supervisor over when it became clear that she was not yet ready to work on real clients (she’d already spent half an hour just nervously combing and staring and her scissors had not yet been opened). The supervisor immediately stepped in and finished my cut swiftly and professionally, while explaining each step to her student.

      Why didn’t your resident’s supervising OB step in just as quickly when it was evident that instructions were just not working? Far more serious than a simple haircut…

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  2. My father died from cardiomyopathy, 2 years later my mother and i requested to get my heart checked out for safety and her exact same words were “oh no your fine.” 5 years after my fathers passing i got a new family doctor and asked for tests and he sent me on my way. well turns out i have dialated cardiomyopathy just like my dad did.

    she also told my brother he didnt have cancer when he did.

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    1. Hello Cassandra – I’m guessing there were no apologies for any of these unfortunate missed diagnoses. Please consider sharing your perspective with Dr. Fiona MacDonald directly by email in her research on this important topic.

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  3. Hi Carolyn,
    I received an apology from my cardiologist and it was the most sincere one of all times. Not at all what I would have expected but one that changed my life forever and it made me do everything within my power to live. I have heard his words over and over again in my head for the past 7 years, 8 months, and 24 days.

    My cardiologist apologized because he couldn’t fix my heart. He said I had too much extensive irreversible damage and that I would need a transplant. He never thought I would leave the hospital. I made up my mind that i was going to live no matter what. But thank God, I’m still here and I won’t feel sorry for myself and with each little bit of heart muscle I lose I fight harder to keep what remains.
    Take care,
    Robin

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    1. Hello Robin – as you know, not every medical crisis can be “fixed”, so no wonder what your cardiologist said to you felt truly life-changing, as you say. by email. Please consider telling your story of that apology to Dr. Fiona MacDonald – contact her directly by email.

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  4. In the weeks leading up to my non-STEMI heart attack last February, I was in constant communication with my primary care doctor about a multitude of symptoms in pursuit of a diagnosis. Symptoms kept worsening and then new ones began to develop, including a painful sensation of my heart pounding. In fact, I even wrote to you at that time that I was gearing up to convince my doctor to take my symptoms seriously. He very nearly dismissed my complaints but ultimately did an EKG that came out fine. So, to his credit, he did order a Holter monitor–to measure over two weeks, and sent me home.

    I went home with my monitor, and continued on. Every day the pounding, pressure and pain in my chest was more intense and the episodes were increasing in frequency. But, I couldn’t really call my doctor, could I? After all, I had been to see him, told him all about my symptoms and this is what he decided to do–run this evaluation for two weeks. I just needed to endure.

    I made it exactly a week. Then my poor heart just couldn’t do it anymore and the EMTs had to take me to the ER, and so on …

    Once I was released from the hospital with my three brand new stents, a host of new medications, and thoroughly traumatized from the whole experience, I went to see my primary care doctor for a follow up appointment.

    Everything about him when he walked into the room was so different. First, he was very concerned about how I was actually doing. Second, he actually said that he was sorry for how things happened! He went on to tell me that when things like this happen, he runs it all over and over in his head to think about what the decisions & actions were and what he could have/should have done differently. He truly regretted that he hadn’t followed up with a phone call during the week.

    This was unbelievable to me. I’d never had a doctor “own it” before! In the six months since then, it seems like our relationship has changed as well. Our most recent discussion about another (dramatic and sad) turn in my health was far more infused with empathy and validation than a sense of being “patted on the head”.

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  7. In 1989 I had surgery to remove one or more ribs and cartilage because a visible lump could have been cancer. This was a difficult diagnosis because cartilage cells can be confused with cancer cells. I was prepped for extensive surgery, possibly needing a plate in my chest, and possibly affecting the use of my right arm and hand. As a result, I was given strong and long anesthesia. When I awoke, I was minus one rib, the top, and told there was no cancer. The lump was a growing deformity due to the pressure on that rib. The surgeon sheepishly apologized. I was surprised, because I also thought it was cancer and he was not God, knowing all things. In my elation in knowing I was cancer free, I happily accepted his apology.

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    1. Good example, Pauline, of the challenges in anybody predicting ahead of time with 100% accuracy if a suspected issue is serious or not. The results can range from life-threatening to completely benign – and everything in between. That was a generous surgeon’s apology, likely more of the ‘I’m sorry you had to go through all this’ variety.

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