Too often, none of this happens. A recent survey of several thousand physicians showed that in response to four different scenarios depicting serious, clear-cut errors, less than half (42 percent) would inform the patient that an error had occurred. Even fewer (37 percent) would provide information about preventing future errors. Unfortunately, the study reflects what happens every day in hospitals and doctors’ offices in the United States.
Why is it so hard for doctors to admit their mistakes and apologize? One reason is we’re human. We all find it difficult to " ‘fess up," but it’s even harder when your error has caused someone significant physical harm. In addition, many physicians still cling to the misguided notion that they need to appear infallible to gain patients’ trust and confidence. Admitting an error exposes a chink in that M.D. armor. And if their errors cause serious harm, doctors can feel profound shame and guilt.
But help is on the way. Spurred by outspoken patient advocates, more and more doctors are joining the discussion. In March 2006, the 14 hospitals affiliated with Harvard Medical School released a consensus statement about medical errors that called for full, open, honest communication with patients following an adverse event. Four essential steps were identified.
Tell the patient and family what happened. Doctors should initially just describe the facts and not speculate about how or why the mistake occurred. First impressions and assumptions may be wrong.
Take responsibility. Most errors are caused by many factors, some beyond a single person’s control. And the most effective way to prevent errors is to fix systems and procedures rather than blame individuals. But this shouldn’t be an excuse to pass the buck. Someone, usually the attending physician, needs to accept responsibility.
Apologize at once. Compassion defuses anger and begins to restore trust. If investigation shows that the injury was caused by an error, then a “true” apology should be made. Two elements are essential: accepting responsibility and showing remorse. An apology also helps physicians deal with their feelings of shame and sets the stage for forgiveness by the patient.
Explain what will be done differently in the future. Knowing that some good will come of the mistake helps patients and families cope with the pain or loss caused by mistake. (Read the full statement at macoalition.org.)
Of course, the elephant in the room is the threat of a malpractice suit. For decades, lawyers have counseled doctors and nurses to basically keep their mouths shut and make no admissions or statements of responsibility. However, experience shows that this is bad advice. Disclosure, apology and early financial compensation dramatically reduced the number of malpractice suits at the Department of Veterans Affairs hospitals in the 1990s, and, more recently, in programs run by the physician insurers in Colorado (COPIC) and at the University of Michigan.
Full disclosure with apology is an idea whose time has come. Doctors have always known it was the right thing to do. Now, it appears, it’s also the smart thing to do.
