Concerns about medical liability, insurance coverage and a lack of training for doctors mean an apology after medical errors is the exception. When you hurt someone, saying "sorry" may seem like the least you can do. But when the hurt occurs in the medical arena, offering an apology is not so easy. Thirty-five states have laws offering some kind of legal protection for physicians who express regret or empathy to patients who experience an adverse event. But laws vary in what they protect from admissibility in court. Most insurers discourage doctors from apologizing for fear it could hurt them in court, and lawyers often advise against it. Hospitals are required to tell patients about serious mistakes. But it is unclear to what extent disclosure policies are followed, and these disclosures may not be accompanied by apologies. More than a decade since studies first showed that openness and apology might work, "I'm sorry" is still rarely uttered in medicine. Indeed, it has been more than two decades since the Lexington Veterans Affairs Medical Center in Kentucky, U.S.A., decided to change how it reacted in the aftermath of adverse events. Dr. Kraman and his colleagues at the Lexington VA believed that being honest with patients, apologizing for mistakes and offering financial compensation was both the right thing to do and financially sound. But how did their costs compare with those of other VA hospitals? From 1990 to 1996, the Lexington VA had 88 claims and paid an average $15,622 per claim, compared with a $98,000 average at VA hospitals without "I'm sorry" policies. American Medical Association ethical opinion states that when a doctor errs, "the physician is ethically required to inform the patient of all the facts necessary to ensure understanding of what has occurred" and that liability concerns should not impede disclosure. Douglas B. Wojcieszak is founder of the Sorry Works! Coalition, which promotes the apology, disclosure and compensation concept among physicians, insurers and hospitals, and offers training. Wojcieszak estimates that 5% to 10% of hospitals nationally are taking the "I'm sorry" approach. But, he said, many decline to publicize that for fear of drawing attention from trial lawyers. "There are a lot more hospitals and health care organizations, medical practices and long-term-care facilities that are doing this, but they are just doing it quietly. We're still at the early adopter stage," said Wojcieszak. Rick Boothman is chief risk officer at the University of Michigan Health System, one of the early adopters. He said the reason other doctors and hospitals have been slow to say "I'm sorry" is simple. "What holds us back is fear, and you can't quantify it," Boothman said. "Those fears are not the result of bad experiences -- they're the result of people who've never tried it." Whether barriers to disclosure and apology are legal, organizational, financial or psychological, the moral imperative to tell patients the truth and apologize when called for appears to be gaining headway advocates said. More transparency, fewer lawsuits The University of Michigan Health System in 2002 adopted a policy of investigating adverse events, sharing the findings with patients and families, and apologizing and offering compensation when appropriate. The system says it has cut litigation costs in half and seen new claims fall by more than 40%. Open Claims 2002 - 220 2003 - 193 2004 - 155 2005 - 114 2006 - 106 2007 - 83 Sorry Sometimes Nearly six in 10 doctors have disclosed a serious error to patients, according to a 2006 survey. But whether "sorry" was part of the conversation is unclear. More than 1,200 U.S. physicians were asked about scenarios in which patients were harmed. What would you most likely say about what happened? 56% - Mention adverse event, but not that it resulted from error 42% - Explicitly state that an error occurred 3% - Make no reference to the adverse event or error What would you most likely say regarding an apology? 61% - "I am sorry about what happened" 33% - "I am so sorry that you were harmed by this error" 6% - "I would not volunteer that I was sorry or apologize" Source
