Should Doctors Apologize to Patients?

From a moral perspective, there is no controversy. Practically, this issue is more complex.

The question seems straightforward enough. If a doctor makes a mistake, should he or she apologize for it? Isn’t this simply the right thing to do? Don’t we raise our children to behave in this manner? How can this be controversial?

We have all witnessed how apologizing is a nuanced art form, particularly among those in the political class. We’ve heard the “mistakes were made” version, which is a clumsy effort to insert a layer of passive voice insulation between themselves and their screw-ups. I don’t find this technique to be particularly effective. In fact, this non-apology highlights their self-serving attempt to escape personal responsibility.

There is also the ever-present conditional apology, which by definition falls short of complete acceptance of responsibility. The template here is, “I’m sorry for my oversight, which wouldn’t have happened if….”

Just own it. Apologize unconditionally even if there may be blame beyond your actions. While there are no guarantees in life, the hope is that an authentic mea culpa will permit the aggrieved party to extend some grace. As a result, the relationship can resume or even be strengthened. I’m sure we have all seen this in our own lives.

What should doctors do when we make a mistake? Of course, from a moral perspective, there is no dilemma. When we err, we should admit it and apologize for it. Of course, some medical errors are trivial and do not require us to march into the confessional. If a patient, for instance, receives Oreos when a chocolate chip cookie was ordered, the world will continue to rotate. No foul here. But substantive errors must be disclosed.

Oreos? I didn’t order them! I’m calling my lawyer!

The quandary for physicians is that an admission of error, which is morally required, may be used as a cudgel if they are sued for medical malpractice. Personally, I believe that this concern is exaggerated and that a genuinely contrite and transparent physician may reduce legal vulnerability by explaining what went wrong and remaining committed to the patient’s well-being and recovery. And coming clean is the right thing to do.

Here’s a point that I don’t think is always grasped by the public. An adverse medical event or a mistake is not tantamount to medical negligence. If a blameless adverse event ensues, such as a medication side effect, physicians can express regret that it occurred but not assume culpability. And an initial view that a negligent act has occurred may not be borne out after a full airing of the facts.

However, there are occasions when it is clear that medical negligence has taken place. Wrong-site surgery is such an example. I still maintain that telling the truth is a moral imperative. The physician’s attorney, who is charged with minimizing legal exposure, may have a different view.

Many states have physician apology laws that state that expressions of regret or sympathy are not admissible in medical malpractice trials. Many states also offer protection if actual fault is admitted, such as in my state of Ohio. There are also a minority of states that offer no protection, and any statement of regret or fault would be legally admissible.

I strongly support apology laws which permit physicians to preserve their morality and integrity without incurring legal risk for doing the right thing. These laws serve the interests of physicians and patients.

I’m not offering legal advice in this post. How could I? I’m not an attorney. Consult a real lawyer if you have personal questions on these issues.

So, how was this post? Verbose? Self-serving? Tedious? Arrogant? If so, don’t blame me. Sometimes, mistakes are made.