Why is it so hard for doctors to apologize?

Research suggests that about 70,000 Canadian patients experience serious, preventable injury as a result of medical treatments each year. Further, as many as 23,000 adults in Canada die annually due to preventable errors in acute-care hospitals alone.

Disclosure of medical mistakes to patients is an integral part of patient care, and doctors have an ethical and legal duty to disclose errors to patients. While the duty to disclose is clear, many patients do not discover that their injury or poor outcome is due to medical error until litigation is started. Most provinces have legislation that allows a physician to offer an apology without admitting fault or liability, and a 2006 commentary from the New England Journal of Medicine reported that in systems where medical providers were encouraged to apologize for mistakes causing harm and make reasonable settlement offers, the number of lawsuits fell by more than half. So why is it so hard for doctors to apologize?

Part of the problem is the structure of the modern medical system. Increasing specialization has also depersonalized modern medicine, so that when a mistake is suspected, it might be unclear who from the medical team involved must step up and take responsibility. However, a bigger part may be that our health care culture is focused on denial and punishment rather than learning from mistakes.

In Dr. Brian Goldman’s TED Talk, Doctors Make Mistakes. Can we talk about that? he states that medicine’s culture of shame and denial prevents doctors from talking about mistakes and using them to learn and improve. All doctors make mistakes, he says, but they are taught to “be perfect.” When a mistake is made, doctors and other health care professionals are left alone, ashamed, and unsupported – unable to share their experience with colleagues so that the mistake is not repeated. Health care experts have suggested that releasing descriptions of incidents and lessons learned from them would be the most effective way to educate those in the medical field, yet doing so remains an anomaly in Canada.

As our health care system is run by human beings, human error is inevitable. While some physicians and other health-care professionals communicate with compassion after an error has been made, many simply try to sweep the error under the rug. Dr. Goldman is one of a growing number of physicians looking to redefine the culture of medicine by changing the landscape to one where doctors are able to tell their stories of mistakes, to learn from mistakes, and pass this knowledge on to someone else. These physicians do not see lawsuits and complaints as nuisances to be stamped out, but as the starting point to improving sub-standard care. Mistakes made by others should be pointed out in a supportive way so that everyone can benefit. In this way, it can be better understood why errors happen, what can be learned from them, and how they can be prevented in the future.

Disclosure of medical errors is an integral part of patient care, and can decrease blame, increase trust, and improve relationships. There is no harm in a doctor offering an apology, and much to be gained for health care professionals and patients alike.

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