Anesthesia arrived at a version of this earlier than most of medicine, and not for moral reasons - the malpractice premiums had become unsustainable. The specialty started systematically collecting and publishing its own closed claims, error by error, and what came out of that (mandatory pulse oximetry and capnography, standardised gas connectors) is most of the reason a healthy person's anesthetic is now counted in deaths per hundreds of thousands. None of that happens if the first instinct is to protect the record. The bedside version is smaller and happens constantly: when someone admits in the holding area that they took the pill they were told to hold, the only useful first sentence is thank you for telling me, because the alternative is that I find out from their blood pressure.
@JM, thx for contributing. I remember when med mal insurance CLE premiums in anesthesia were stratospheric. Luckily, this issue has cooled down considerably for all of us.
Well said, Arif. Have my colleagues across the pond had a medical malpractice challenge like we have had here in the States? Fortunately, it has cooled down for us quite a bit in recent yrs. Thx, as always, for reaching out.
I really enjoyed reading your perspective, which I largely agree with. You really described the nuance and position that many physicians can find themselves in. I've found that I can communicate honestly with patients and sometimes this requires apologizing for a variety of reasons. In general, I've been served well by not passing judgement, sharing as much knowledge about what has happened and focusing on shared understanding through clear communication. I love your perspective and learn so much from your writing Michael.
Jake, thx as always for reaching out. Anyone who reads your comment above will benefit, as I did. I surmise that you care for a very devoted cohort of patients.
Excellent and balanced viewpoint as always. I give a talk on this to the family medicine residents that emphasizes not only what happened, the proper contrition and commitment to make things right if possible but also adequate time, privacy and the right people present. For example, if the error occurred due to a hospital policy, an administrative representative should be part of the apology. Patients want honesty and accountability, they almost never want revenge.
Michael, the part I don't have a rule for is the middle. Wrong-site surgery on one side, a medication side effect on the other, and the conversation with the patient can happen before the case has landed at either end.
@LL, excellent point. As you point out, the extremes are much more comfortable to address than the murky middle with its shifting landscape and unclear ultimate consequences. I think nuance and transparency can coexist. We don’t have to have ll of answers at every moment in the life cycle of the event. Patients, I think, will understand this, as everyone deals with uncertainty. I think that being open and communicating that we - the physicians - will see it through is the best we can do. I don’t feel I have more expertise on this than you or many of our colleagues do. It’s not exactly a medical issue. Thx for reaching out.
Thanks for the conditional apology at the end 🤣 As a cancer patient who has navigated healthcare extensively, this is a question I actually wondered about. The legal aspect didn’t escape me, but it sure would be nice if doctors apologized once in a while. It would also show humility, which is a highly sought-after quality. Nice article.
@TCS, thx for adding your thoughts. I agree with you that apologizing is an expression of humility and that many in the medical profession could use an extended release dose of this. I’m a work in progress on this and other aspects of doctoring, along with many of my colleagues.
Anesthesia arrived at a version of this earlier than most of medicine, and not for moral reasons - the malpractice premiums had become unsustainable. The specialty started systematically collecting and publishing its own closed claims, error by error, and what came out of that (mandatory pulse oximetry and capnography, standardised gas connectors) is most of the reason a healthy person's anesthetic is now counted in deaths per hundreds of thousands. None of that happens if the first instinct is to protect the record. The bedside version is smaller and happens constantly: when someone admits in the holding area that they took the pill they were told to hold, the only useful first sentence is thank you for telling me, because the alternative is that I find out from their blood pressure.
@JM, thx for contributing. I remember when med mal insurance CLE premiums in anesthesia were stratospheric. Luckily, this issue has cooled down considerably for all of us.
This is such a great read! Sometimes a heartfelt sorry (even if you feel like you did nothing wrong) can go a long way!
Well said, Arif. Have my colleagues across the pond had a medical malpractice challenge like we have had here in the States? Fortunately, it has cooled down for us quite a bit in recent yrs. Thx, as always, for reaching out.
I really enjoyed reading your perspective, which I largely agree with. You really described the nuance and position that many physicians can find themselves in. I've found that I can communicate honestly with patients and sometimes this requires apologizing for a variety of reasons. In general, I've been served well by not passing judgement, sharing as much knowledge about what has happened and focusing on shared understanding through clear communication. I love your perspective and learn so much from your writing Michael.
Jake, thx as always for reaching out. Anyone who reads your comment above will benefit, as I did. I surmise that you care for a very devoted cohort of patients.
Excellent and balanced viewpoint as always. I give a talk on this to the family medicine residents that emphasizes not only what happened, the proper contrition and commitment to make things right if possible but also adequate time, privacy and the right people present. For example, if the error occurred due to a hospital policy, an administrative representative should be part of the apology. Patients want honesty and accountability, they almost never want revenge.
Elliot, it is not surprising that you practice and model the same high level of humility in your professional arena as you do in your personal life.
Michael, the part I don't have a rule for is the middle. Wrong-site surgery on one side, a medication side effect on the other, and the conversation with the patient can happen before the case has landed at either end.
Not clear yet, and already time to say something.
You've made both ends much easier to see.
@LL, excellent point. As you point out, the extremes are much more comfortable to address than the murky middle with its shifting landscape and unclear ultimate consequences. I think nuance and transparency can coexist. We don’t have to have ll of answers at every moment in the life cycle of the event. Patients, I think, will understand this, as everyone deals with uncertainty. I think that being open and communicating that we - the physicians - will see it through is the best we can do. I don’t feel I have more expertise on this than you or many of our colleagues do. It’s not exactly a medical issue. Thx for reaching out.
I liked the explanations which were rational and common sense.
Thanks for the conditional apology at the end 🤣 As a cancer patient who has navigated healthcare extensively, this is a question I actually wondered about. The legal aspect didn’t escape me, but it sure would be nice if doctors apologized once in a while. It would also show humility, which is a highly sought-after quality. Nice article.
@TCS, thx for adding your thoughts. I agree with you that apologizing is an expression of humility and that many in the medical profession could use an extended release dose of this. I’m a work in progress on this and other aspects of doctoring, along with many of my colleagues.
I would add humor, as you so eloquently showed at the end, goes a long way.