Apologize for Your Error

On May 18, 2008, The New York Times published an article entitled "Doctors say 'I’m sorry' before 'see you in court.'" The author touched on a very important subject, one that has perhaps directed the compass of medical practice in USA: from a patient-centered, bold but passionate, innovative but evidence-based form of medical care to a defensive practice, where a lawsuit is always hanging at the back of every practitioner’s mind. One where enormous sums of time and money are spent doing tests that are completely unnecessary and often done only to protect oneself, “just in case.” This culture has driven physicians out of business, turned obstetrics into a feared art, and raised neurosurgery malpractice premier to more than twice the income of an average family. With Texas’ newly passed tort reform, physicians are now flocking to obtain a Texas medical license. A cousin of mine, who recently finished his surgical residency, does not want to work in Florida, Pennsylvania, etc, because of high malpractice cost.

Now, however, spring is in the air and with it, a new season of novel concepts, such as "accept your mistake," and "apologize for your error." There has been a 360-degree change from never accept fault, deny, and defend, to a new approach which is shaking the basic tenets of the medico-legal syllabus. I can just imagine malpractice lawyers shaking their heads in disbelief, safeguarding the sacred verse: "prove it." But really, is telling the truth and taking responsibility for your mistakes such a difficult concept? Apologizing for ones mistakes is the basic and fundamental thread which weaves the fabric of our society and builds relationships. What does it say then, when we read in The New York Times that only 30% of medical mistakes are revealed to the injured party (the patient)? If we consider that only 2% of the injured patients press legal claim, we should feel shameful and embarrassed.

It is refreshing to note, as mentioned in the article that University of Michigan health system, that the University of Illinois and Harvard affiliate hospitals are adopting a full disclosure policy. Take the patient aside, and in confidence, be candid, truthful and honest. A full disclosure policy will take away the sting of concealment and suspicion. University of Michigan is reporting almost 65% decline in lawsuits, while the reduction in University of Illinois case is 50%; successes based entirely on physicians accepting and admitting their errors. I say it is time such practice became the rule, rather than the exception. Unfortunately, we are not nurtured, counseled or prepared on how to best approach such a conversation. But while it may not be easy, we need to change the environment to one trust, truth, disclosure and accepting responsibility for errors.