Unfortunately things do go wrong in healthcare and sometimes patients are dissatisfied, disappointed or upset with the care that they have received. Medical Protection supports open communication, and we encourage members to apologise where things have gone wrong, regardless of fault.
Medical Protection has long advised members that an apology is not an admission of liability; rather, it is an acknowledgement that something has gone wrong and a way of expressing empathy. Contrary to popular belief, apologies tend to prevent formal complaints rather than the reverse.
When should an apology typically be offered?
An apology should be offered as soon as it becomes apparent that an adverse incident has occurred (regardless of fault) or the patient is unhappy with their care.
It is important that patients, or their families, receive a meaningful and timely apology. It may be sometime before all the facts, and perhaps the reasons why and how the events occurred, are understood. Until these are established, speculation should be avoided as this is unhelpful to all involved. However, this consideration should not hinder a prompt apology being forthcoming.
Depending on the circumstances the process may require a number of meetings with the patient and / or their family over a period of time as the full picture of what has happened is established. At the initial contact, the doctor may not have answers to all the patient’s questions or adequate explanations. If so, the doctor should say so, but commit to endeavour to establish them and report back to the patient.
The culture in a hospital, GP practice, clinic and so forth, should allow doctors the freedom to apologise. It is ethically and professionally the right thing to do – irrespective of the cause.
What is an ‘appropriate’ apology?
An apology, expressing regret about the patient’s experience or emotions, is not an admission of liability and is appropriate when a patient has suffered harm from their healthcare or experienced disappointment.
For instance I am sorry this happened to you
Rather than I am sorry I caused this to happen to you and it’s my fault...
An appropriate apology should be tailored to the situation – reflecting the patient’s perception of the issue. It should also be put into context, so all parties understand the purpose of the apology. Ownership should also be taken by a senior clinician/GP. Fundamentally, an apology should be offered willingly, and not perceived to have been given reluctantly.
We would always advocate a full and objective review of the event, with the patient being informed as to any lessons that can be learnt moving forward. A commitment should be made to understand and learn from what has happened to reduce the likelihood of it recurring and happening to someone else.
Where it is clear that care was below standard or a mistake, or error, was made, that fact should be acknowledged in the apology. Typically, this should only be done after discussion with senior colleagues. Depending on the seriousness of the situation, advice may also be sought from the doctor’s medical defence organisation (MDO).
On occasions it may be appropriate to waive fees or follow up costs, or offer some reimbursement of expenses as a gesture of good will. Again, advice should always be sought about this course of action in any given situation.