Page last updated at 05:00 GMT, Wednesday, 19 May 2010 06:00 UK

Why 'sorry' shouldn't be the hardest word for doctors

VIEWPOINT
Dr Anthea Martin and Dr Gail Gilmartin
Senior medical advisers with the Medical and Dental Defence Union of Scotland (MDDUS)

Many fear we are living in a blame culture - something has gone wrong, so somebody must pay.

A patient and GP. Pic:Suzanne Grala/SPL
Sometimes an apology can be enough

In the NHS doctors may fear both litigation and censure.

But in this week's Scrubbing Up, medical law experts Dr Anthea Martin and Dr Gail Gilmartin tell doctors that most of the time patients just want a simple apology.

Some patient, at some time in a doctor's career, will complain about them.

It's a certainty doctors must get used to from day one after leaving medical school.

Gone are the days of unquestioning respect for doctors - a poll carried out by MORI revealed that four out of five members of the public would make a complaint about their doctor if they felt cause to.

The family did not want to litigate but was driven to it by a continued refusal by the hospital to apologise and admit that mistakes had taken place

Patients increasingly see themselves as medical consumers with a right to quality service and an explanation when treatment falls short of expectations. Along with this they often want and expect an apology.

But "saying sorry" to a patient can sometimes be difficult for doctors.

The worry is that it might imply an admission of liability and thus invite medico-legal action or lead to punitive disciplinary action by their employer, or action by their regulator the General Medical Council (GMC).

Patient safety incidents can have devastating emotional and physical consequences for patients and their families, and can be distressing for the professionals involved.

Research has shown that openness about adverse incidents and discussing them promptly, fully and compassionately can help patients and professionals cope more effectively with the after effects.

An appropriate and well-delivered explanation and apology has been shown to be effective in diffusing complaints and preventing their escalation.

There are also examples where the lack of a sincere apology can result in prolonged court action.

Sorry needn't be the hardest word

A famous case in Ireland in the late 1990s is a perfect example - where a previously healthy young man died aged 21 when a treatable illness was not detected due to a series of errors, mix-ups and clinical blind spots.

The family did not want to litigate but was driven to it by a continued refusal by the hospital to apologise and admit that mistakes had taken place.

During the highly expensive five-year litigation process, the family met a wall of resistance before finally receiving an apology and finding out exactly what had gone wrong. The victim's mother freely admits that a simple apology at the time of her son's death would have been enough and avoided the costly and traumatic court action.

Be open

A meaningful apology requires a sincere expression of regret but more than that it requires an acknowledgment of responsibility for the harm caused.

In addition an explanation of what went wrong should be provided and reassurance that the problem has been addressed or will be addressed and will not happen again. Where possible verbal apologies should be provided but this must be followed up with a written apology.

The MDDUS has advised in many cases where a sincere and well-worded apology from a doctor or other healthcare professional has prevented possible legal action.

In one recent case a child was administered the same vaccine twice in error by his general practice. A letter written by the GP was sent to the child's parents expressing the surgery's regret and providing a full explanation of what went wrong and how systems would be changed to prevent it happening again.

The parents were satisfied with this and took no further action.

A culture of openness among patients and professionals as well as the organisations with whom they work is vital. Staff must be supported and not become victims themselves of a culture of blame.

Most patients are not interested in persecuting doctors. One study of complaints found that the primary concern of patients was to ensure that the same thing did not happen to another patient.

Only 7% who complain do so in the hope of financial compensation.

An apology will rarely make a situation worse and is widely recognised as the right thing to do as it may prevent the matter from escalating.

Sorry needn't be the hardest word.




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