Why physicians hesitate to apologize after errors

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For physicians and other frontline healthcare workers, apologizing is an essential step in addressing medical errors and building a trusting relationship with patients, Paolo Spriano, MD, writes in an Oct. 17 viewpoint published by Medscape.

“When done properly, an apology can have profound healing effects for everyone involved,” Dr. Spiano writes. “For clinicians, it can help ease feelings of guilt and shame; for patients, it can foster forgiveness and for the basis for reconciliation.”

Dr. Spriano writes that patients who seek legal action after a medical error are not always doing so for solely financial compensation, but often perceive a lack of apology, sincerity or accountability. While legislation and policy surrounding medical negligence continues to update, Dr. Spriano claims that patients continue to report unsatisfactory responses and clinicians frequently cite the fear of legal liability as a top reason for not apologizing. 

In England, apology legislation was proposed, in which apologies would become inadmissible as evidence in court. This would, in theory, encourage more open and honest communication without posing legal risk. International evidence supports the idea that receiving an apology can positively impact patients and families, yet fear of litigation or blame still tends to hold clinicians back from apologizing. According to Dr. Spriano, legal advisors in the U.S. frequently discourage clinicians from apologizing, as it is seen as an admission of guilt that may invalidate liability insurance. 

Healthcare professionals, regulators and leaders must “acknowledge the dual healing role of an apology,” Dr. Spriano writes. “It can ease the compounded harm experienced by patients and families while also supporting the mental wellbeing of clinicians – often referred to as the ‘second victims.’

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