Patients Respond Favorably to Apologies

Physician's Money Digest, August15 2004, Volume 11, Issue 15

When faced with a patient who has experienceda bad outcome, the response ofmany medical malpractice experts hastraditionally been "defend and deny."While numerous studies have shown that open and honestphysician–patient communications can lower theincidence of malpractice suits, until recently, admitting amedical mistake to a patient hasn't often made thecut. Doing so could leave the door wide open to a malpracticesuit, some malpractice mavens say.

Preventive Measures

Wall Street Journal

That mindset is being challenged at some prestigioushospitals across the country, according to arecent report, includingBaltimore's Johns Hopkins Hospital and Boston'sDana-Farber Cancer Institute. Both hospitals have apolicy in place that urges doctors to admit mistakesand apologize to patients when errors have been madein treatment. In some hospitals, particularly those inthe Veterans Administration system, an honesty policy,under which patients are told when mistakes aremade and victims are compensated, has been in effectfor as long as 15 years.

The trend is showing up elsewhere as well. Somemedical schools now have mandatory courses formedical students and residents that teach them how totalk about treatment errors and apologize for them.Malpractice insurers, including Medical Protective, aunit of General Electric, are also looking at whether asincere apology can stave off a potential suit. Afterlooking at claims data, Medical Protective has concludedthat communication is a major factor in manylawsuits. Some malpractice plaintiff lawyers are evenagreeing. It's much harder to make a winning case,they say, when the other side has already admittederror and apologized to the patient.

The way the apology is handled can be critical. Onemalpractice insurer, while endorsing the idea of havingphysicians apologize for errors, makes doctors take acommunications course in which apologies are carefullystructured. Under the course guidelines, any apologyshould be phrased in language that doesn't put toomuch of the blame on the physician.

Beyond Apologies

Annals of Internal Medicine

An article in the showsthat patients who aren't notified of a medical error andreceive no apology are 1.5 times more likely to seek outa malpractice lawyer than those patients who receiveapologies. Still, an apology for a medical error shouldnot be seen as a panacea against lawsuits. Some patientsmay appreciate the apology but still feel that some sortof compensation should be offered.

A strategy of an apology coupled with compensationcan be a potent malpractice deterrent, according toCopic (www.copic.com), a Denver-based malpracticeinsurer. The insurer asks doctors to report any injuries orcomplications and responds to the patient within 72hours with an offer to cover lost wages and any additionalmedical expenses. The approach is reducing theoverall number of malpractice claims and cutting theaverage payout. Copic's average claim cost for the 146cases in its program over the past 2 years is $4300, comparedwith an average of $52,000 for all claims and lawsuitsagainst the firm in the past 5 years.

According to the supporters of the say-you're-sorry-and-pay approach, most patients are happy to get a fairsettlement within a few months rather than file a malpracticesuit and hope for results in 3 to 5 years.