I'm Sorry

Apologizing to a patient is the right thing to do,” says Michael S. Woods, MD, a general surgeon at St. Vincent’s Regional Medical Center in Santa Fe, N.M. “It is the respectful thing in any relationship in terms of trust whenever there is a violation, whether it is real or perceived.” Dr. Woods, the author of Healing Words: The Power of Apology in Medicine, teaches and consults with corporations around the country about apology as well as physician leadership.1-2 In fact, his study of apology stemmed from examining the subject of physician leadership, and he and other experts consider the vital components of leadership to be effective communication, integrity, honesty, and respectful treatment of other individuals.3,4

Dr. Woods also works with Doug Wojcieszak, a public relations consultant whose victims’ rights group proposed “Sorry Works!” This program recommends apologies and settlements when medical mistakes occur. (See “A History of Sorry Works!” p. 26.) Dr. Woods says Wojcieszak comes from an interesting angle that he supports. “Something I increasingly try to hammer home when I speak is that one of the most important components of the apology law has nothing to do with the backhand of the reduction of litigation as much as the fact that it gives the physician the green light to say ‘I’m sorry,’” says Dr. Woods.

The Benefit of Healing

Providers may be less than open when things go terribly wrong because of feelings of fear, shame, and guilt regarding the consequences to the patient as well as to themselves.1,3 Apology heals by restoring the patient’s dignity and self-respect, providing assurance of shared values, and assuring patients that they are not at fault, they are now safe, and that the caregiver shares their suffering.4,7

Two Senses of Apology

There are circumstances other than when errors occur in which a physician’s apology may carry the power to improve patient care. Peter Barnett, MD, MPH, a clinical associate professor of medicine at the University of New Mexico in Albuquerque, says that in general there are two senses of apology.

“The first sense of apology regards the situation,” he says. For example, you might say, ‘I’m sorry you have cancer,’ or ‘I’m sorry that our system doesn’t allow your family doctor to be taking care of you in the hospital.’ It’s an expression of sympathy, but I think apology works better.”

The other sense of apology regards responsibility, says Dr. Barnett, citing the example, “I’m sorry I gave you the wrong drug.”

Situational needs for apology include when patients have been waiting a long time, such as when a hospitalist meets them in the emergency department. “In those cases you would say, ‘I’m sorry that you had to wait so long,’” says Dr. Barnett. “It’s not my fault, but I really am sorry.”