The Physician's Corner

By Henry Tulgan, M.D., FACP

The medical community and others now appreciate that apology for medical mistakes may reduce malpractice litigation and even in successful actions, reduce awards. This change in approach from the traditional silence when errors occur has been endorsed not only by most physicians, but also by attorneys, risk managers, administrators and insurers. In many states, laws have been enacted to protect physicians who apologize to varying degrees and the topic has been the subject of recent books and articles in national medical journals.
How comprehensive an apology should be is less clear. Although some experts advocate full disclosure, others suggest a more simple empathetic statement. The key in either case is how genuinely the statement is expressed. What is evident is that each patient should be dealt with individually.
Dr. Aaron Lazare, former Dean and Chancellor of University of Massachusetts Medical School and renowned author on the subject of apology, gives the following definition: (1) an admission of responsibility for an offense followed by expressions of regret, remorse & forbearance, (2) justification or explanation (apologia).
Dr. Lazare also cautions that there are various types of failed acknowledgements that include offering a vague and/or incomplete offense; using the passive voice; making the offense conditional; minimizing the offense or using the empathic “I am sorry.”
In all adverse situations, apologies should be prompt and sincere. If promises are made to follow through on investigating the circumstances more fully, this action must be taken, documented and communicated to the relevant parties. Since litigation of malpractice may not occur for several years, legal experts advocate having a thoughtful communication strategy in place immediately after the adverse incident has taken place.
Some health care institutions have begun to craft specific policies in this area. Legislators in 35 states, including Massachusetts, have an apology law on the books. But to date, there is no standard model.

Risk Management Strategies

• Apology is now considered appropriate when medical mistakes occur.
• Apology may reduce litigation or awards.
• Apology should be sincere and empathetic but should not assume physician responsibility for the event.
• Litigation may be delayed for several years.
• Follow through promises must be kept.

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