How Apologies Lead to Fixing

I’ve talked before about blamers and fixers. Here’s a way of looking at that concept that may make you a wiser patient.

One of the big questions about medical mistakes is whether practitioners should own up to them. Until recently, doctors were highly discouraged from admitting any kinds of problems had taken place, whether it was prescribing the wrong medications or amputating the wrong limb. The thought was that by admitting guilt, they would be setting themselves up for losing lawsuits.

Once again — the concept of blame creates problems. The fix is what might seem surprising.

Studies have shown that in fact, when doctors are willing to accept responsibility enough to apologize, and review and learn from their mistakes, malpractice lawsuits are far less likely to be filed. In fact, a study undertaken at the University of Michigan Hospital where they have a policy of disclosure for both errors and near-misses, reflected a two-thirds reduction in medical malpractice claims, according to All Things Considered on NPR.

Clearly — taking responsibility can even save money!

What no one I know about has yet examined is this: why does that happen? Why can something as simple as a doctor’s apology keep a patient from filing a lawsuit?

Here’s my guess at the reason:

When young children misbehave, they are blamed for the problem they caused, then taught by their parents to apologize. The apologizing itself is deemed a way to begin the “getting beyond” whatever their indiscretion was, both for the misbehaver and for whomever the victim was. Also, as children, when someone hurts us or does something we know was wrong against us, we are taught to learn to accept an apology as the first step toward forgiveness. That’s how we learn the beginnings of closure, and we learn to depend on closure as the way to get over whatever happened.

Later, when something bad happens to us that we have no control over, we human beings want to blame. It gives us something to focus on. We blame the terrorists for 9/11. We blame the government for Katrina problems. We blame faulty design for the Challenger blowing up. Sometimes we even blame God, or whomever we revere, when something horrible happens that we can’t point any other finger at.

Often, that finger-pointing blame is appropriate. Who or whatever we blame deserves it, and what we want is for the object of our blame to then feel appropriately guilty — and therefore to apologize. The acceptance of that guilt is what lets us begin the closure process. Any healing that may take place will be based on that closure.

The Institute of Medicine tells us up to 98,000 Americans are killed by medical errors or misdiagnosis each year — which means 98,000 doctors deserve the blame. When those 98,000 doctors were told they were not allowed to apologize, then families of the victims had no way to begin their closure process by accepting an apology and starting to forgive. They needed to find closure in some other way. So they filed lawsuits.

That the number of malpractice lawsuits were reduced to one-third of previous levels because doctors are allowed to apologize, should therefore come as no surprise. In fact, in the NPR story used to illustrate the point, not only did the victim of the medical error feel relieved that she had been apologized to, but she further stated that she felt as if they had listened to her, and had learned from the mistake made on her, so that another woman wouldn’t suffer later from the same mistake. She no longer felt like a victim. In fact she felt like she had inspired something very positive.

The NPR story said that up to 70 percent of hospitals are now leaning in the direction of disclosure and apologies. That’s excellent. I hope to hear soon that 100% of hospitals are buying in.

And what can patients do in the meantime?

In my opinion, we can measure how patient-centered a hospital is by examining its policy about error disclosure. If they support disclosure, and allow their doctors to apologize and learn from errors, then they are far more likely to be interested in outcomes for patients than those hospitals that don’t support this sort of transparency.

So, taking this idea another step: as patients, if we think we may need to be hospitalized in the near future, we can actually use this information to our advantage. Call the hospital and ask what their policy is. Ask a doctor who has an affiliation at that hospital what their policy is.

Are they forthcoming and pro-learning? Or are they offended that you asked the question so they dance around the answer?

See what they respond, and how they respond. Tune in to their attitude. It can tell you a lot. And that might make a huge difference in your hospital experience.


Learn more about doctor’s apologies here.

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5 thoughts on “How Apologies Lead to Fixing”

  1. From the time I entered medical school in 1997, we were taught to always own up to mistakes and to discuss them with patients to help allay concerns. I find it somewhat disingenuous that you make the comment, “until recently doctors were highly discouraged from admitting to mistakes”. I am fairly certain you made that one up. I would like to see your research on that because ten years ago hardly qualifies as recently. I have gathered from your website that you seem to have a chip on your shoulder regarding doctors. If you are so distrustful of physicians, then I suggest you stop using our services. I will never understand people like you who think the government can do a better job at health-care considering Medicare/Medicaid are horribly beaurocratic and wasteful ventures. Perhaps you should preach a little personal responsibility in your blogs. People all want a 60inch plasma TV but they bitch about paying $25 for a vaccination. As a physician I don’t even require praise and compliments…I’d be just as happy with a simple thank you…Instead, people like you make us all out to be a bunch of rude, incompetent idiots who don’t care about what we do. I suggest you get some information off of something other than liberal hate-rag websites before you spew your ignorance

  2. MPJ, If you entered med school in 1997, then you’ve been practicing for less than 10 years and yes — “recently” when you consider the history of modern medicine would be 10 years or even more.

    Clearly you have read very few of my blog posts. In fact, what you would learn if you did, is that I often praise medicine and the doctors who are part of it because I realize they are trying to do their best with one or both arms tied behind their backs. Knowing that’s true, I try to help patients collaborate with their physicians better.

    Regarding apologies — literally, it has been only the past few years — perhaps as many as 10 — that med schools have taught their students that it’s OK to own up to mistakes. Here are some articles, dated 2004 and 2005, that would indicate that what I say is true. (Contrary to your statement, I don’t make these things up!)

    Do you consider CBS and the Boston Globe to be “liberal hate-rags”? I certainly don’t.

    The concept of blamers and fixers has nothing to do with how health care is delivered. What it does do is create an atmosphere where everyone can improve a situation by understanding why a problem happened, then making sure it doesn’t happen again.

    I hope you will realize that attacking people like me — who are only here to help patients collaborate better with their doctors — are not the enemy.

    Trisha Torrey

  3. Trisha
    It’s not often that someone who has never been to medical school tells me what I was taught in medical school. With the advance of medical therapeutics and technology, “recently” goes back only about a year. This same concept applies to people such as yourself who have never spoken to the 5 doctors in my family including my father who all said that apologizing to patients about complications has long been part of the medical lexicon. Trying to avoid apologizing to patients is a long-standing habit of hospitals and the lawyers who advise them…not physicians. The two articles you linked clearly show this. The articles are quoting hospital CEO’s and administrators. The clear message is not that physicians are starting to apologize, it’s that HOSPITALs are starting to apologize. No physician is bound by any hospital contract of non-disclosure. It would be a clear violation of medical ethics to ascribe to such a principle. Unfortunately, in this day and age, when a complication does occur, the first people to weigh in are the risk-management personnel who, admittedly, often attempt to take the place of the physician and “resolve” the situation. I do find it interesting that you chose CBS as an example of a non-biased, non-liberal news-source. The same CBS who ran with a story about a forged document about Pres. Bush…and we all know that Boston sits in the middle of the liberal hot-bed of America. You might want to come after me with a few different informed sources to back up your claim (as I said before) that “only recently” have doctors been taught to apologize. This is nothing more than a line you use to back up your wreckless claim.
    There is nothing in those posts that state that apologizing has ever been added to any med school curriculum. Full disclosure and compassion have long been found in the penumbrum of med school training…just because someone wrote about recent policy changes in HOSPITALS (in a likely attempt to appease bloggers like you) doesn’t mean this is a recent event. No med school has ever (to my knowledge) had a class entiltled “Aplogizing to Patients”. Its taught in medical ethics which has been taught for decades.
    The concept of blamers and fixers is a design of the legal community and the few maligned patients who feel wronged by the medical community. And i don’t see how it improves a situation. All it does is to make people afraid of it and tell them who to blame for it…and also where they can get a helluva lot of money from a jury for it.
    And, yes, Trisha people like you are sometimes the enemy. Running a blog that frequently espouses physicians as “narrow-minded” “non-critical thinkers” who are “too rushed to talk to patients” and often “fall back on anecdotes as diagnoses” is very irresponsible. I often read your blog and have agreed with some of what is said. Your readers love to say that physicians are uncaring, selfish, and God-like – and you do nothing to counter their claims. It makes my stomach turn every time someone refers to physicians as all having God-complexes because they watched a few TV shows which seem to love to drive home that very misconception. Actors on TV are no substitute for the real thing. Physicians have families…we have kids…we have home lives…we pay taxes…we go to movies. Please don’t confuse us with soap operas or bad acting by Alec Baldwin. Unfortunately we had to spend 4 years of college killing oursleves to get into medical school. Then we had to spend upwards of 100 hrs per week studying and rounding and seeing patients for 4 years of medical school. Add another 3-7 years of working 80-90hrs per week in residency to that. And don’t forget that many had to forgoe family and friends and lots of other luxuries during all this time just so we could acquire enough information to treat patients effectivley. Trust me, you don’t go through all of that if you truly don’t care about the people you see every day. I can’t tell you how many sleepless nights I have had when you see what patients and their families have been through at times. Seeing these things puts life into a greater perspective than you could ever comprehend. We get to live this and at the same time read blogs by people like you who love to put us in little boxes and label us as uncaring, unapologetic, ego-mongers. Medicine has been a blessing for me because I get to put into action the very morals and priciples that make us human…the concepts of caring for the weakest amongst us at great personal cost are something we do. And all of this gets thrown out the window when one person experiences the 1 in 100,000 complication…suddenly we are risk-takers and ass-coverers in your world.
    I have yet to read a blog post by you that has praised doctors. You said yourself that we often do our jobs with our arms tied…this is true at times. Perhaps you could find time to write about what life is really like for physicians. Write about the endless lawsuits we deal with…write about the size of the homes that the insurance CEO’s and malpractice attorneys live in. Write about how my father (a pediatrician) gets paid $25 by medicaid but the ER gets paid $600 to see the same patient for the same ear-infection. Maybe write about the recent study done by the Am Assoc of Trial Attorneys which showed that 40% of all malpractice lawsuits are frivolous and their average payout is ~$50,000 (which was viewed by them as being successful in that it showed that the ONLY 40% were frivolous and that the majority of lawsuits are valid – if you consider 60% a large majority).
    You see Trisha, physician’s don’t get the luxury of having an advocate because we are all different, but mostly because we are all taught to incorporate compassion into our practices…this is something which dates back to the days of Hippocrates. Also, because we are human we are also patients for our own medical problems – this gives us the unique advantage of experiencing medicine from both sides of the fence…most patients do not get to be doctors and thus will never be able to walk a mile in our shoes.
    While I don’t doubt that patients need an advocate at times, I don’t quite understand why that advocacy has to include labeling us as untrustworthy and nefarious. People, for some reason, will always believe what people like you say and hold it as gospel over our heads even to their own detriment. I pray that you find a way to write about how the overwhleming majority of physicians are here to help, not hurt… but that sometime bad things happen to good people and frequently without fault on either side. Thanks…Marc

    PS: I encourage you to contact me at my e-mail address if you like… I hate to feel like I am attacking you in front of your readers, but I feel I have much more to say about alot of your posts…thanks

  4. Gee Marc. If you didn’t want to attack me in front of my readers, then you could have used MY email address — which is listed very clearly under my photo.

    Actually — I believe these posts are quite cathartic for you — you get to do your complaining very publicly. I say — go for it! I’m all for my readers seeing all sides of stories. You might even consider starting your own blog?

    Several times now you’ve attacked me by suggesting I never say anything about the good physicians who are out there, or I never show the physician’s “side”. You are wrong. I think you just read the ones that will allow you to go crazy in rebuttal.

    So for your edification, here are a few of them:

    There are dozens more.

    As far as whether I ever talk to physicians — in fact, I talk to several of them each week while preparing for, and then broadcasting, my radio show. I find them all to be compassionate and professional and appreciate their participation and their knowledge.

    But when I talk about the problems with physician apologies, and abdication of their responsibilities for admitting mistakes — that is my personal experience — not opinion at all — REAL experience with my own misdiagnosis and the very arrogant, very egocentric oncologist who insisted I undergo chemo despite that fact that I was able to prove, eventually, that I had no cancer at all. (If you want to read about it — it’s on the “About Trisha” page. )

    My situation had nothing to do with a hospital and everything to do with arrogance and income. Apologies? ha! Not even close.

    And the concepts of “blamers” and “fixers” is mine and mine alone. I made it up to illustrate the excellent work on the part of my colleagues who are doing wonderful advocacy work to benefit patients AND physicians.

    Marc — the system is VERY broken, and frustrations are everywhere on all sides. But at the end of the day, when mistakes are made, it’s the patient who pays the price of lost health, lost opportunities, and for almost 100,000 Americans a year, a lost life.

    And that’s who I’m trying to teach. I’d much rather a patient be over cautious than further debilitated — or even dead — when they might have been able to protect themselves.


  5. And by the way Trisha…I was inviting you to contact me by e-mail because people tend to treat each other less viciously when not posting on a public blog…that and I figured the e-mail posted under yoiur pic would be posted here also…thats why I invited you to contact me at my personal e-mail.

    And a final thought… Having someone die as a result of a medical mistake is no doubt an egregious error and a tragedy in and of itself. I would like to ask you… How many people would die each year without physicians? You can’t have it both ways Trisha. There will always be mistakes for as long as humans are involved with medicine.

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Trisha Torrey
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