An apology's healing power

By Arthur L. Caplan

How should doctors and nurses deal with their mistakes? Should an apology be part of the response?

The answer is yes, and Pennsylvania lawmakers should pass a bill that would encourage more care providers to say they're sorry for their mistakes.

Unfortunately, there are plenty of reasons for doctors, nurses, and health-care administrators to be apologizing. A study published this year in the journal Health Affairs reported that care mistakes are far more common than previously thought. It found, incredibly, that one in three hospital patients experiences an "adverse event" such as a preventable infection or the wrong medication or surgical procedure. As a result, many are readmitted for expensive treatments to fix mistakes, and tens of thousands die. One leading expert has said our health-care system is putting up with an error-related death rate equivalent to three jumbo-jet crashes every two days.

The problem is so severe that the Obama administration recently announced a billion-dollar initiative to combat errors. It seeks to bring together hospital executives, employers, insurers, physicians, nurses, patient advocates, and government to find ways to make care safer. It aims to reduce avoidable errors by 40 percent and hospital readmissions by 20 percent.

A sustained push for safety is obviously warranted. But a lot of mistakes will nevertheless continue to occur in hospitals, nursing homes, and home-care programs. When they do, how can we get those responsible to admit them and apologize?

Lawyers and insurers in Pennsylvania and other states have long counseled doctors and hospitals to "deny and defend." Many warn clients that any admission of error or fault - even a heartfelt expression of regret - is likely to invite litigation, jack up premiums, and ruin careers. The tens of billions of dollars spent on malpractice insurance, claims, and litigation every year have done little to change this advice.

In teaching medical students, residents, and staff at my own hospital and others, I have seen the impact of the fear of litigation firsthand. All too often, never daring to say "sorry" is the norm.

But many studies have shown that admitting and apologizing for errors actually saves money. A policy of aggressive acknowledgment of errors and thoughtful apologies at the University of Michigan Health System, for example, led to a 50 percent reduction in lawsuits. It also reduced per-claim and malpractice-insurance costs.

Sadly, in today's world, doctors and others who want to apologize need to be protected from those who would use their honesty against them in court. Many states have enacted laws that shield apologies from admission as evidence in malpractice suits. The Pennsylvania House passed similar legislation earlier this year, and the state Senate should follow suit.

This legislation would do nothing to diminish patient rights, but it would do a great deal to encourage the words that can help both patients and those who care for them deal with the cost of mistakes: "I'm sorry."

He can be reached at caplan@mail.med.upenn.edu.