Medical Errors: Should you apologize?

In December 2003, 13 months before she died of liver cancer, the journalist and essayist Marjorie Williams wrote a column for The Washington Post about why she felt uneasy about Howard Dean's presidential bid. Her chief complaint: "The man is a doctor. . . . Where else but in medicine do you find men and women who never admit a mistake? Who talk more than they listen and feel entitled to withhold crucial information?"

Williams' cynical take on the medical profession-the result of a long illness during which she saw dozens of physicians and medical students in several different settings-is unfortunately shared by many people. The problem is compounded by the fact that even physicians who are inclined to acknowledge mistakes and discuss adverse medical events with patients are discouraged from doing so, most often by malpractice insurers. But insurers, hospital administrators, educators, and other major players in the medical profession are starting to notice that the words "I'm sorry" can mollify angry patients-and might increase the likelihood that an injured patient will settle out of court, or not sue at all.

Clear data has yet to emerge on whether disclosure of medical errors saves doctors and insurers money, but from an ethical standpoint, many experts say honesty is the best policy. "It's consistent with our commitment to medicine and with the oath we took when we entered the medical profession," says pediatrician Gerald B. Hickson, associate dean for clinical affairs and director of the Center for Patient & Professional Advocacy at Vanderbilt Medical Center in Nashville.

What to say-and not say-when something goes wrong

If you determine that you have indeed erred, Hatlie and other experts in physician/patient communication recommend a prompt, straightforward apology that steers clear of medical jargon and finger-pointing and focuses on the facts. This should be done in person, says Hatlie, not via e-mail or telephone.

"It's important to review what you'll say and to have answers to questions you can predict," says FP Sarah P. Towne, assistant dean of clinical education at Touro College of Osteopathic Medicine in Vallejo, CA. "Charging in without doing your homework is ill-advised and might leave everyone feeling worse." Additionally, as with most sensitive conversations, the "how you say it" factor is crucial. Experts recommend the following:

Set the scene. "Choose a private area where no one will interrupt," says Brenda Sumrall Smith, a clinical social worker and family therapist in Brandon, MS, who teaches medical students communication skills. "Sit next to the patient rather than across from her, to convey that you're in fact on her side," Smith continues. "Having a desk between you and the patient creates a gulf and makes you seem distant and separate."