Guest post by Dr. Fiona MacDonald, Dr. Karine Levasseur and Dempsey Wilford
You’ve just undergone surgery. Somehow, a mistake was made. The result is that you were harmed when you expected to be healed.
Hurt, angry and scared, you look to your doctors and ask: “What now? What do you have to say?” And they are silent. .
Medical errors like this occur regularly. One report estimates that for every 18 hospitalizations in Canada, one patient will experience harm.
Yet, doctors are hesitant to apologize for medical mistakes. This occurs despite the fact that many jurisdictions in the U.S., Australia and the U.K. already have “apology legislation.” Here in Canada, nine of our 10 provinces and two territories have this legislation in place to allow doctors and other medical professionals to apologize to patients when things go wrong – without having this apology used as evidence of fault in court.
So why is it so hard for your doctor to apologize?
Fear of litigation and loss of respect
To investigate the impacts and difficulties surrounding medical apology, we’ve conducted research on medical apologies over the last two years.(1)*
Most recently, we have interviewed a variety of stakeholders including patients, caregivers, physicians, psychologists, patient safety advocates, medical school administrators and healthcare administrators on their experiences with medical error and apology.
We heard from doctors and other medical professionals who wished to apologize, but were constrained by different social and professional factors.
Our preliminary results show that clinicians receive mixed messages on the topic of apology. Some messages are rooted in an understanding of the apology legislation and provide a supportive environment to allow an apology to the patient to occur.
But other messages are rooted in:
- fear of litigation
- loss of insurance coverage
- loss of respect
- a culture of perfectionism that starts in medical training
- a feeling of shame about harming a patient
As one senior medical professional said:
“Physicians are not designed to make mistakes. They see it as a horrific personal failure when they have made an error. So it is a huge trauma to physicians.”
An apology is healing
Our research shows that apologizing for medical errors is a crucially important step in healing — for patients, families and medical professionals.
Apologizing helps validate the harms experienced by patients, and helps doctors come to terms with their mistake and restore confidence in their practice.
One patient participant in our study said that an apology is healing and that in the trauma of a critical incident, people expect apologies:
“You do something wrong, you apologize.”
Apologizing involves empathizing with patients and maintaining the integrity of medical relationships. As one senior doctor said:
“From my point of view, the benefits of having apology legislation is (to) allow you to take a different perspective in (your) relationship with patients.
“If that relationship is honest and fulsome, it provides you with an opportunity to feel how the patient feels, or at least close to it.”
Forgiveness is not guaranteed
If there is no apology or a poor quality apology, this has a detrimental effect on the relationship between a patient, their family and the doctor, and also on the sense of trust the patient and family place in medical institutions.
The absence of an apology also leaves patients and families in a communicative vacuum and fails to recognize the ongoing harms and trauma resulting from error.
A poor quality apology can also be botched by failing to acknowledge the mistake or wrongdoing adequately, or at all. Such botched apologies include statements such as, “I am sorry you’re hurt” rather than, “I am sorry I did that to you.”
To be sure, apologies are not a cure-all for harms resulting from a medical error, and forgiveness cannot be guaranteed. Litigation and medical apology are also not mutually exclusive. While an apology is given, litigation may still be needed — especially if the medical error resulted in an inability to work or death.
Apology legislation can contribute to the transformation of health care to become less about anger and the pursuit of lawsuits, and more about empathy, forgiveness and the pursuit of understanding to overcome the culture in medicine of “sealed lips”, and to promote learning.
Accountability can be considered as “continuous improvement” through learning rather than blaming.
Silence after an error is profoundly detrimental.
When a meaningful apology is given after an error, it can promote healing, strengthen medical relationships and transform our understanding of care in medical spaces.
More work is needed to help medical professionals understand the protections of apology legislation and the benefits of apologizing.
In doing so, we can conquer the silence.
Q: Have you ever received a medical apology?
♥ *Contact Dr. Fiona MacDonald directly if you have a medical apology experience you’d like to contribute to her ongoing research (read this post first to learn more:) The medical apology: have you ever received one?
Canadian Patient Safety Institute’s “Conquer The Silence” initiative
Swan image: Marcus L, Morguefile
This article is republished from The Conversation under a Creative Commons license. Read the original article by Dempsey Wilford, University of Victoria; Dr. Fiona MacDonald, Associate Professor and Department Head, Political Science, University of The Fraser Valley; and Dr. Karine Levasseur, Associate Professor of Political Studies, University of Manitoba.
NOTE FROM CAROLYN: I wrote much more about our doctor-patient communication in my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press (and use the code HTWN to save 20% off the list price).