I’m Sorry

Start Early and Let It Flow

Dr. Woods’ advice is to offer apology earlier rather than later and to widen the spectrum of those to whom you wish to show your empathy, sympathy, respect, and compassion.

“What I promote to organizations is that they drive this into the consciousness of the organization by getting people to apologize for the least infraction—not waiting for the grave errors.” He interprets this as apologizing “when you’re running 30 minutes late, apologize when you’ve interrupted the patient or the family when they’re speaking. These are the things we would do for our spouse or our significant other or our family members; why is it any different at work?”

He also believes it is inherent for doctors as leaders to “apologize to your staff members, apologize to the nurses.” Because the image you express serves as a role model in this regard and will permeate your practice culture. Drive respectful treatment as a basic common social courtesy into the organizational consciousness, says Dr. Woods, and then in any circumstance where an apology is offered, it is perceived as authentic.

Conclusion

Hospitalists may find a need to apologize to patients and families for situations and circumstances in the hospital environment as well as the gap in relationship that exists when hospitalists and patients first encounter each other. Apologizing early rather than later as well as simply and authentically goes a long way to help achieve the ethical and business objectives held by most hospital physicians. TH

Andrea Sattinger wrote about error reporting in the May issue.

References

1. Woods MS, Star JI. Healing Words: The Power of Apology in Medicine. Santa Fe, N.M.: Doctors in Touch; 2004.
2. Woods MS. Applying Personal Leadership Principles to Health Care: The DEPO Principle. Orlando, Fl.: American College of Physician Executives; 2001.
3. Leape LL. National Patient Safety Foundation. Understanding the power of apology: how saying “I’m sorry” helps heal patients and caregivers. Focus on Patient Safety. 2005;8:1-3.
4. Lazare A. On Apology. Oxford, U.K.: Oxford University Press; 2004.
5. Boothman RC. Apologies and a strong defense at the University of Michigan Health System. Physician Exec. 2006 Mar-Apr; 32(2):7-10.
6. Weber DO. Who’s sorry now? Special report: patient trust and safety. Physician Exec. 2006 Mar-Apr:32(2)6-14.
7. When Things Go Wrong: Responding to Adverse Events. A Consensus Statement of the Harvard Hospitals. Burlington, Massachusetts: Massachusetts Coalition for the Prevention of Medical Errors; 2006.
8. Barnett PB. Rapport and the hospitalist. Am J Med. 2001;111:31S-35S.
9. Leape LL. Full disclosure and apology—an idea whose time has come. Physician Exec. Mar-Apr 2006 32:16-18.
10. Beckman HB, Markakis KM, Suchman AL, et al. The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med. Jun 27 1994;154(12):1365-1370.
11. Cohen JR. Apology and organizations: Exploring an example from medical practice. Fordham Urban Law J. 2000;27(5):1447-1482.
12. Cohen JR. Advising clients to apologize. South Calif Law Rev. 1999;72:1009-1069.
13. Entman SS, Glass CA, Hickson GB, et al. The relationship between malpractice claims history and subsequent obstetric care. JAMA. 1994 Nov 23-30;272(20):1588-1591.
14. Gesensway D. Hospitalists and the malpractice insurance crisis. The Hospitalist. 2002Jul/Aug;11-13.
15. Levinson W, Roter D, Mullooly JP, et al. Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997 Feb19;227(7):553-559.
16. Lo B. Ethical and policy implications of hospitalist systems. Dis Mon. 2002 Apr;48(4):281-290.
17. Mello MM, Studdert DM, Brennan TA. The new medical malpractice crisis. New Engl J Med. 2003 Jun 5;348(23):2281-2284.
18. Shapiro RS, Simpson DE, Lawrence SL, et al. A survey of sued and nonsued physicians and suing patients. Arch Intern Med. 1989 Oct;149(10):2190-2196.
19. Zimmerman R. Doctors’ new tool to fight lawsuits: saying ‘I’m sorry.’ Malpractice insurers find owning up to errors soothes patient anger. ‘The risks are extraordinary.’ J Okla State Med Assoc. 2004 Jun;97(6):245-247.
20. Ambady N, LaPlante D, Nguyen T, et al. Surgeons’ tone of voice: a clue to malpractice history. Surgery. 2002 Jul;132(1):5-9.
21. Wu AW. Handling hospital errors: is disclosure the best defense? Ann Intern Med. 1999 Dec 21;131(12):970-972.
22. Localio AR, Lawthers AG, Brennan TA, et al. Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III. N Engl J Med. 1991 Jul 25;325(4):245-251.
23. Brennan TA, Sox CM, Burstin HR. Relation between negligent adverse events and the outcomes of medical-malpractice litigation. N Engl J Med. 1996 Dec;335(26):1963-1967.
24. Hickson GB, Federspiel CF, Pichert JW, et al. Patient complaints and malpractice risk. JAMA. 2002 Jun 12;287(22):2951-1957.
25. Stelfox HT, Gandhi TK, Orav EJ, et al. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005 Oct;118(10):1126-1133.
26. Pham HH, Devers KJ, Kuo S, et al. Health care market trends and the evolution of hospitalist use and roles. J Gen Intern Med. 2005 Feb;20(2):101-107.
27. Harris Interactive(R). Telephone survey conducted for the American Academy on Physician and Patient, March 3-6, 2006.