Most accomplished physicians will, at some point in a successful career, have to confront at least one unanticipated, serious, or even catastrophic outcome.
Still, these are uncommon events, and many physicians are under-prepared to manage the physician-patient relationship in this setting. In the context of a litigious public and the Internet, which has forever changed access to information for non-physicians, the management of an adverse event requires expert communication skills.
This article focuses on the value of one essential communication skill: a carefully planned and sincere apology. We have interviewed two professionals who are experts in this area: Michael Woods, MD, a surgeon and author of Healing Words: The Power of Apology in Medicine, and Robert Morton, risk manager for American Physicians Insurance Co.
Why do patients sue?
Dr. Woods and Morton point to numerous studies showing the inverse relationship between physician communication skills and the likelihood of being sued after an adverse event. Those with the best communication skills ask the patients more questions, encourage patients to talk about their feelings, use humor when appropriate, and educate patients about what to expect during their treatment. Those with enhanced communication skills spend a few more minutes with their patients-about 3 minutes per visit-than those physicians who have been sued. Another fact worth noting is that the likelihood of a lawsuit decreases by 50% when an apology is offered and the details of the medical error are disclosed in a timely fashion.
Dr. Woods suggests that an authentic apology is one that is heartfelt and driven by true regret or remorse. He says you should apologize when necessary because it demonstrates that you respect the patient, you are taking responsibility for the situation, you care about how the patient feels, and it shows your empathy. The result is that anger dissipates.
Patients want to know what happened and why it happened, how the problem or error will affect their health in the short and long terms, what is being done to correct the problem, who will be responsible for the cost of the error or complication, and, finally, what has been learned and what the doctor is doing to prevent this from happening again.
Dr. Woods cautions that a poorly planned apology can be as bad or worse than no apology at all. Begin by admitting to yourself what has happened to the patient. Next, think about the ramifications of your actions or inactions leading to or causing the problem. Look at the situation from the patient's point of view and try to understand his feelings. It is also important to forgive yourself for any causal role you had in the incident. Finally, plan and prepare your apology. This may even mean writing out what you intend to say, how you want to say it, and when you should say it.