If I accidentally bump into someone and hurt them walking along the street, my immediate reaction is to say sorry, regardless of whether it was or wasn’t my fault. Admittedly there may be some eye-rolling and huffing on my part if I then realise they had stopped because they were looking at their mobile phone. But regardless, apologising is just the right thing to do for both parties. In fact, our Britishness dictates that this is the acceptable response in such a situation.
What happens when we place a similar analogy into a doctor/patient context? Acknowledging the distress of a patient or their relative with an appropriate apology, following an adverse outcome, shows compassion. Most healthcare professionals have this in abundance, but it can at times be hidden behind a rigid professional mask. This is largely due to the challenging claims environment, and the fear doctors have of being sued or reported to the GMC – the myth that apologising puts a doctor at greater risk of a complaint or claim has been difficult to quash.
Thankfully, attitudes do appear to be shifting. A recent Medical Protection survey shows that 86 percent of GPs believe saying sorry can stop a complaint from escalating. 82 percent think an apology can help restore a good doctor/patient relationship, and 72 precent of GPs say they do not believe saying sorry is an admission of liability.
We also asked the public for their views, through a YouGov survey of over 2,000 people in Britain. 76 percent said they would not be likely to make a complaint if the GP apologised about the issue they were going to complain about. Both sets of results speak for themselves about the healing power of those simple words: “I’m sorry”.
Medical Protection has long advised doctors that an appropriate apology is not an admission of liability; rather, it is an acknowledgment that something has gone wrong and a way of expressing empathy. We also provide advice, education and practical tools which help with communication during difficult and highly emotive conversations, as we know too well that things aren’t always straightforward in practice.
Increasing patient expectations are also a factor. While doctors may feel more comfortable about apologising after an adverse outcome, they may feel less inclined to do so if the patient is dissatisfied due to unrealistic expectations which have not been met. Our own analysis shows that 86 percent of GPs sometimes, most of the time or always encounter challenging experiences with patients when they do not provide the prescription, treatment, or referral to a specialist they request. In an environment like this, it is easy to understand why a doctor may question when an apology is appropriate and worry about the implications.
I go back to my initial analogy of accidently bumping into someone when walking along the street, and apologising because it’s the right thing to do. The culture in healthcare should really be one of openness and honesty so professionals feel they can apologise with confidence, without the fear of being sued hanging over them.
Such a culture would aid learning from any mistakes that have contributed to an adverse patient outcome, and make improvements, minimising the risk of the same thing happening again. This is an increasingly important debate for all in healthcare today, and for society as a whole.