Mike Huckabee is professor and director of the physician assistant program at UNMC. He worked as a physician assistant for 30 years, primarily in rural Nebraska. Read more from Mike here.
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Maybe it was the penicillin mistakenly prescribed despite a documented allergy. Or an operation on the wrong side of the body. Or a misinterpreted blood test. The clinician says to the patient, “I'm very sorry that things did not go as expected.”
Does that make everything alright?
Over the past decade, 35 states, including Nebraska, have enacted “apology laws” to support open and honest communication between health care providers and patients. Saying “I'm sorry” comes with some benefits and risks. Here's what we've learned thus far.
There are two types of doctor-patient apologies recognized by the law. The first, involves no admission of guilt. It's the two words, “I'm sorry…,” leaving implications unknown. Such an apology could mean, I'm sorry you're hurting, I'm sorry this happened or I'm sorry I got caught. This type of apology is used sincerely by clinicians to express sympathy regarding an unanticipated outcome. The words are specifically chosen to avoid taking blame.
The second type is an honest disclosure of an error. This is the heartfelt apology admitting the wrong. “We made a mistake, and we regret the suffering it has caused. We're sorry.”
There are three keys to an effective apology. A noble apology is more than words, and these principles are needed for “sorry” to mean it. Make restitution. Act respectfully. And learn from the error.
Most states' apology laws prevent expressions of sympathy from later being used in malpractice lawsuits. However, if fault is admitted, the law does not protect the doctor from having the actual admission of fault being brought up. For good or bad, Nebraska's apology law follows this design.
Several states go even farther to protect clinicians who make an apology and admit fault. In these states, their words cannot be used against them if legal action is taken.
The University of Michigan Health System has become a leader in responding to medical errors. Their self-described Michigan Model has reduced malpractice claims and awards to the plantiff , and more importantly, prevented future mishaps. This model follows the same three principles:
• Compensate those harmed if mistakes led to an injury.
• Support the health care professionals who provided reasonable care.
• Improve patient safety by learning from the problem.
It's important for the medical community to keep exploring and how to make the best of them. For another take on the issue, here is a New York Times Op-Ed video on physician apologies.
VIDEO: Can you count how many times David Tennant (The Tenth Doctor) says "sorry" in 2:19 minutes?