Poll: Should doctors apologize after a medical error?

Despite the fact that almost 100,000 patients die from medical mistakes each year, only 30 percent of those errors are ever disclosed to patients. Saying “I’m sorry” is morally and ethically proper. It re-establishes trust and empathy between doctor and patient, and makes it easier for everyone involved to learn from the incident. Hospitals that have instituted full disclosure programs have seen a decrease in the number of malpractice lawsuits and a savings in legal costs.

But is it advisable for doctors to fully disclose their mistakes? For years, lawyers told physicians to “deny and defend,” but the protection offered to doctors varies, and is less than ideal in many cases. Thirty-five states have enacted laws making apologies inadmissible in court, but saying “sorry” can result in an increase in malpractice premiums – often by tens of thousands of dollars a year, if not outright denial of malpractice insurance.

So, while hospitals seem to benefit from apologies, it’s not clear whether saying “I’m sorry” is in doctors’ best interest.

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Comments

Dr. IKE
It’s such a catch-22, you know? Personally, I have no problem making an apology when it’s necessary. In many cases, young doctors like myself are told doing so shows a lack of confidence which is bound to decrease your standing in the patient’s eyes.
It’s tough for me to resist the impulse, as I often think out loud to some extent, but it may rely on a sense of the patient’s (litigious) attitude more than anything.
Anonymous
One of the problems (not just with medicine) is that the law has made “responsibility” synonymous with “blame”, when they are not the same. Reponsibility is accepting that when you have the ability and resources to improve a situation, you should — no matter how the problem was created. When I look at my medical clinic’s web page, I see every page footnoted by “We take no responsibility…” Seems very wrong. Shouldn’t I be able to have some expectations that they will take responsibility?
On the patient side, I don’t like what lawyers (including risk management attorneys) and insurers have done to medicine any more than you. I can’t believe that doctors and patients together are powerless here.
Anonymous
i think we’re supposed to say “i’m sorry that this happened to you” rather than “i’m sorry that i did this to you”
get rid of the lawyers and i’ll happily apologize.
Anonymous
Strange how repeating something enough times makes it a fact.
Lawyers and politicians have repeated the medical error estimates from IOM’s 1999 study so many times that even physicians accept as fact that almost 100,000 patients die from medical mistakes each year.
The truth is, we don’t have any reliable nationwide data on how many people die or are injured by medical errors.
According to the very studies that the IOM misused, injuries due to medical care has been decreasing – from a rate of 4.6 percent in 1976 California, to 3.7 percent in 1984 New York, to 2.9 percent in 1992 Colorado and Utah.
To be sure, it isn’t statistically valid to compare different regions like that, but it is precisely this misuse of statistics that allowed the IOM to overstate medical errors nationwide.
And they did so while ignoring the decreasing rates of injury over the years.
Physicians must continue to promote patient safety efforts because one medical error is too many. But physicians shouldn’t validate the misperception that patients are being harmed by mistakes in ever greater numbers.
If jury verdicts are any indication, few of the claims are due to mistakes, since 70% of them end in favor of the physician.
Anonymous
“…only 30 percent of those errors are ever disclosed to patients”
Are doctors really scratching their heads wondering why patient trust is so low?
Anonymous
“If jury verdicts are any indication, few of the claims are due to mistakes, since 70% of them end in favor of the physician.”
I think you are guilty of selection bias here. The really egregious errors never come before a jury because they’re generally settled out of court. The cases that *do* end up before a jury tend to be more equivocal in nature – differing interpretations of medical judgment, parties who refuse to settle because they’re convinced they’re right, and so on.
It’s not really known how many people who’ve sustained a medical injury end up suing, but the best estimates available are that it’s fewer than 10 percent. It would be interesting to know why this is; is it because these patients/families haven’t been told the truth?
So no, jury verdicts are really not any indication; they are merely a tiny slice of the overall picture which you are inflating to suit your argument.
I really don’t know why you people continue to quibble over the IOM numbers. That’s like quibbling that The Gulag Archipelago grossly overstated the number of people that Stalin killed; it wasn’t 10 million, it was really 1 million, blah blah blah. Even if 25,000 or 10,000 patients die from preventable medical errors in the U.S. every year, that’s still way too many.
I’m trying to figure out why you claim, on the one hand, that we don’t have accurate data on how many patients are injured by errors each year… yet on the other hand the injury rate has been decreasing over the years. How do we know it’s decreasing if we don’t have accurate data?
Anonymous
“Get rid of the lawyers and I’ll happily apologize.”
I am a lawyer in Texas who has happened upon this site, and although most of the conversation here is very insightful and well-said, the undertone above has been, is now, and always will be a continuing conflict between those who practice law and those who practice medicine. And, it hides the real bad guy in the whole scenario, which is the malpractice carrier.
“Tort Reform” in Texas has killed medical malpractice. The maximum cap is $250,000. For most lawyers, with the amount of expert testimony (because no medical expert works for free), combined with the cap on damages, means that it is EXTREMELY difficult to take on a med-mal case.
Now, I know the readers here are thinking “Good! Just what I want!”
What you don’t know is the the medmal premiums have not fallen as a result of the severe drop in medmal claims. So basically, the insurance company is pocketing the doctors’ premiums, while the patients, who have suffered terrible loss at the hands of gross negligence, cannot seek any justice for the wrong done to them and their families.
A suit for malpractice is the only way that those wronged by a professional can truly recover their damages. It’s a fact of life that professionals need this insurance to protect themselves from their mistakes. Doctors do, lawyers do, CPAs do.
Giving victimized clients / patients a single course of action of hoping that the powers that be in the professional community punish the negligent professional is unreasonable and unjust.
And some people here won’t even give an apology.
Anonymous
Spoken like a true lawyer.
Every thing you do as a doctor can drastically affect someone’s life and you’re liable for all those effects. Patients can lie and not follow directions and if something goes wrong, they can sue. It’s not a big deal to lawyers, but I’m sure most of them haven’t been sued.
Anonymous
“Patients can lie and not follow directions and if something goes wrong, they can sue.”
And doctors can lie and not note their actions in the chart and the patient will never know what caused their problems. Still, you don’t, or shouldn’t, make policy based on sketchy anecdotal evidence.
Anonymous
Anon 6:19. You were spot on when you pointed out that if something is repeated enough, it becomes fact. The 100,000 number is used so often people have forgotten that the landmark IOM study actually estimated “as many as 44,000 to 98,000 people die in hospitals each year as the result of medical errors.” It was much better from a media point of view to use the larger end and initially say “almost 100,000″ which morphed into simple parroting of the 100,000 commonly quoted. Of note, also, is the definition of error:
“The IOM emphasized that most of the medical errors are systems related and not attributable to individual negligence or misconduct.” So we are not really talking about malpractice usually or physician specific actions and thus blur who or whom should be making an apology if any. These points would unfortunately not generate nearly the reader interest so they were conveniently downplayed in many ways. The important point remains: research has shown that system improvements can reduce the error rates and improve the quality of health care.
That should continue to be our motivation.
Anonymous
“These points would unfortunately not generate nearly the reader interest so they were conveniently downplayed in many ways.”
True. And it goes the same way with most of the “statistics” used by tort reform proponents. When lobbyists use statistics, whether you agree with their position or not, you should always apply a healthy bit of skepticism.
Anonymous
Interesting since you say that since you can make the same argument with tort reform opponents
Anonymous
As Mark Twain said, there are lies, damn lies and statistics. Both sides selectively use statistics. What they mostly do is extrapolate pretty narrow findings into broader statements without any qualifiers. You’ll see the “reformers” do this more, but then they’re a more organized group with more money as a group at stake.
There really are few firm statistics from nonpartisan sources on the issue. I would bet the insurers have the most detailed information, but they’re not about to give unfettered access to their databases.
The Thinker
Medicine is not a exact science. It is not possible to be perfect in the management of disease. The patient ought to bear some risk. If a patient seeks treatment for a gall bladder stone and he is told that a cholecystectomy is the way to go, and that there are some risks inherent to the procedure – the procedure is done if he gives informed consent. If he sustains a CBD injury following the procedure, is that deemed a mistake or just hard luck? I would say that he entered the contract with eyes wide open and hence has to bear consequence of the risks he has taken. Similarly if a 28 week premature baby loses a limb due to a misplaced IV. as unfortunate as it seems, the child simply has to bear the risks of treatment.Only if the patient accepts these risks can the doctor begin treatment.

Poll: Should doctors apologize after a medical error?

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