Hard to Say You’re Sorry

“I am sorry.” Three little words. Yet in healthcare, such a high hurdle. Most of us learn in childhood that a sincere apology is a useful tool for repairing damaged relations, easing relatives’ hurt feelings, and generally restoring goodwill with those close to us. Yet with a handful of notable exceptions, the concept continues to elude most hospitals, health systems, and physicians - another casualty of our lawyered-up medical culture. But only in part. I get it: Something goes wrong, and the first thing you worry about is the lawsuit. The decent thing to do is to offer the clearest explanation you can - and apologize, if you or someone on your team erred. But in today’s sue-first, ask-questions-later world, you might as well just hand over your checkbook with that approach, right? Well, no. Thirty-five states offer protection to docs who apologize. The laws vary, but generally they’re intended to let you be honest with your patients without worrying that what you say will be used against you in court. Moreover, a significant body of research over the last decade has concluded that well-crafted policies that include open inquiries about the causes of adverse events and - when warranted - apologies and settlement offers have reduced, not increased, the number of lawsuits and the amount paid out annually in liability claims. As American Medical News reminded us recently, the VA hospital in Lexington, Ky., found in 1999 that its average payout per claim was 86 percent lower than other VA hospitals in the six years after implementing such a program. Some other hospitals, most notably the University of Michigan, have followed suit, with similarly positive results. But most have not. No more than one in 10 hospitals have “I’m sorry” programs in place, according to one estimate. I doubt the percentage among private-office docs is any higher. Yet our readers consistently ask us for advice on how to keep the trial lawyers at bay; hence this month’s feature by Sara Michael, “Lawyer Repellant.” And one way to repel the lawyers is to simply say, “I’m sorry.” Our image of patients speed-dialing 1-800-LAWYER the second something goes awry is a myth. Both sides of the trial bar will tell you that most people sue their doctors when they suspect they’re being jerked around.Rodney Adams, a Richmond, Va. lawyer who defends doctors for a living, told us that “we often hear during depositions from a patient or family member that ‘Nobody ever told us what happened,’ or ‘The doctor wouldn’t talk to us.’” Does that mean you should apologize every time something bad happens? Of course not. Complications happen in healthcare, and it’s not appropriate to take blame for something that isn’t actually your fault. But you can still offer a sympathetic “I’m sorry” - as you might for a friend whose loved one has died. Just be careful about (and document) what you actually say, then call your insurer’s risk-management office. Tell them you want help with an investigation into what happened, and inform the patient of the results. Also, bear in mind if you haven’t had open communication with your patient from the beginning, you can’t expect an apology to carry much weight after something goes wrong. Be your patient’s advocate and confidant from the get-go. Bob Keaveney is editorial director for Physicians Practice. He can be contacted via e-mail at bob.keaveney@cmpmedica.com. This article originally appeared in the March 2010 issue of Physicians Practice.