How Apologies Lead to Fixing

I’ve talked before about blamers and fixers. Here’s a way of looking at that concept that may make you a wiser patient.

One of the big questions about medical mistakes is whether practitioners should own up to them. Until recently, doctors were highly discouraged from admitting any kinds of problems had taken place, whether it was prescribing the wrong medications or amputating the wrong limb. The thought was that by admitting guilt, they would be setting themselves up for losing lawsuits.

Once again — the concept of blame creates problems. The fix is what might seem surprising.

Studies have shown that in fact, when doctors are willing to accept responsibility enough to apologize, and review and learn from their mistakes, malpractice lawsuits are far less likely to be filed. In fact, a study undertaken at the University of Michigan Hospital where they have a policy of disclosure for both errors and near-misses, reflected a two-thirds reduction in medical malpractice claims, according to All Things Considered on NPR.

Clearly — taking responsibility can even save money!

What no one I know about has yet examined is this: why does that happen? Why can something as simple as a doctor’s apology keep a patient from filing a lawsuit?

Here’s my guess at the reason:

When young children misbehave, they are blamed for the problem they caused, then taught by their parents to apologize. The apologizing itself is deemed a way to begin the “getting beyond” whatever their indiscretion was, both for the misbehaver and for whomever the victim was. Also, as children, when someone hurts us or does something we know was wrong against us, we are taught to learn to accept an apology as the first step toward forgiveness. That’s how we learn the beginnings of closure, and we learn to depend on closure as the way to get over whatever happened.

Later, when something bad happens to us that we have no control over, we human beings want to blame. It gives us something to focus on. We blame the terrorists for 9/11. We blame the government for Katrina problems. We blame faulty design for the Challenger blowing up. Sometimes we even blame God, or whomever we revere, when something horrible happens that we can’t point any other finger at.

Often, that finger-pointing blame is appropriate. Who or whatever we blame deserves it, and what we want is for the object of our blame to then feel appropriately guilty — and therefore to apologize. The acceptance of that guilt is what lets us begin the closure process. Any healing that may take place will be based on that closure.

The Institute of Medicine tells us up to 98,000 Americans are killed by medical errors or misdiagnosis each year — which means 98,000 doctors deserve the blame. When those 98,000 doctors were told they were not allowed to apologize, then families of the victims had no way to begin their closure process by accepting an apology and starting to forgive. They needed to find closure in some other way. So they filed lawsuits.

That the number of malpractice lawsuits were reduced to one-third of previous levels because doctors are allowed to apologize, should therefore come as no surprise. In fact, in the NPR story used to illustrate the point, not only did the victim of the medical error feel relieved that she had been apologized to, but she further stated that she felt as if they had listened to her, and had learned from the mistake made on her, so that another woman wouldn’t suffer later from the same mistake. She no longer felt like a victim. In fact she felt like she had inspired something very positive.

The NPR story said that up to 70 percent of hospitals are now leaning in the direction of disclosure and apologies. That’s excellent. I hope to hear soon that 100% of hospitals are buying in.

And what can patients do in the meantime?

In my opinion, we can measure how patient-centered a hospital is by examining its policy about error disclosure. If they support disclosure, and allow their doctors to apologize and learn from errors, then they are far more likely to be interested in outcomes for patients than those hospitals that don’t support this sort of transparency.

So, taking this idea another step: as patients, if we think we may need to be hospitalized in the near future, we can actually use this information to our advantage. Call the hospital and ask what their policy is. Ask a doctor who has an affiliation at that hospital what their policy is.

Are they forthcoming and pro-learning? Or are they offended that you asked the question so they dance around the answer?

See what they respond, and how they respond. Tune in to their attitude. It can tell you a lot. And that might make a huge difference in your hospital experience.

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Learn more about doctor’s apologies here.

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Posted in: Doctor Communication, Health /Medical Consumerism, Healthcare Quality, Hospitals, Media, Medical Errors / Mistakes / Misdiagnosis, Patient Advocacy, Patient Empowerment, Patient Safety, Patient Tools, Self Help

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1 Comment

  1. Marc J November 4, 2007

    And by the way Trisha…I was inviting you to contact me by e-mail because people tend to treat each other less viciously when not posting on a public blog…that and I figured the e-mail posted under yoiur pic would be posted here also…thats why I invited you to contact me at my personal e-mail.

    And a final thought… Having someone die as a result of a medical mistake is no doubt an egregious error and a tragedy in and of itself. I would like to ask you… How many people would die each year without physicians? You can’t have it both ways Trisha. There will always be mistakes for as long as humans are involved with medicine.
    Marc