On communication – the value of apology

Clinical care can result in undesirable outcomes. Sometimes we make mistakes. Sometimes the system fails. Sometimes undesirable outcomes just happen. Research suggests that patients and their families get frustrated (and then more often sue) when we do not acknowledge the problem – The power of an apology: Patients appreciate open communication

While doctors and lawyers duked it out over tort reform and liability caps in state legislatures last spring, two states quietly passed bills that could significantly impact malpractice lawsuits by extending physicians’ freedom of speech to include two words: “I’m sorry.”

The Colorado and Oregon legislatures passed laws allowing physicians to make statements of sympathy and condolence with the assurance that these statements would not be used against them later in court.

“The world is a crazy place,” said Oregon Medical Assn. President Colin Cave, MD, a Lake Oswego-based otolaryngologist. “Who would have thought that a doctor would have to be protected by a law in order to express his or her compassion?”

California, Massachusetts and Texas already have similar laws, but many doctors and hospitals are discovering that, even without legal protection, acknowledging and apologizing for errors and adverse outcomes has its own rewards, both ethical and financial. There also is optimism that disclosure will lead to better communication that might help prevent errors in the first place.

When errors do occur, studies indicate that it’s not necessarily the medical error itself that causes patients or their families to sue, but the response to it. A study in the Feb. 26 Journal of the American Medical Association reported that after an error occurs, patients want information about why it happened, how consequences will be mitigated and what’s being done to prevent reoccurrence. They also want emotional support from doctors — including an apology.

“Patients will keep looking until their questions are answered,” said Ilene Corina, president of Persons United Limiting Substandards and Errors in Health Care, an advocacy group for people affected by medical errors. “If all the doors are closed to them, they will go to lawyers.”

The typical posterror scenario, Corina said, is that the patient or family can’t reach doctors and instead are circled by risk managers who won’t give straight answers. “The classic line you hear is, ‘We’re looking into it,’ ” said Corina, whose 3-year-old son died 13 years ago after surgery to remove his tonsils and adenoids. “In my case, the doctor said he was sorry but never acknowledged that something went wrong.”

I hate the entire concept of risk management in medicine. I try to discuss all issues openly with patients. Probably I only succeed sometimes, but I will continue to work on improving my communication.

Good communication skills do lead to better patient care, better enjoyment of the doctor patient relationship, and according to this article less need for risk management. I try to teach communication to students, interns and residents when we make bedside rounds. I only hope that I am sometimes successful.