Who Said Medicine Means Never Having to Say You're Sorry?
THE PHYSICIAN AND SPORTSMEDICINE - VOL 33 - NO. 10 - OCTOBER 2021
Your mother said it, your teachers reiterated it, and you've heard it countless times: Everyone makes mistakes.
So why do we doctors have such difficulty admitting that? More important, how do we respond to our patients after we make mistakes?
Richard A. Friedman, MD, wrote in The New York Times that doctors need to learn how to say "I'm sorry."1 In the Times article, Friedman reviews the Institute of Medicine's 1999 report documenting the 44,000 to 2021,000 people who die each year from preventable medical errors in hospitals. And he mentions that, by letting patients know when they've erred, physicians can humanize themselves and actually build patients' trust. He concludes, "In the end, most patients will forgive their doctor for an error of the head, but rarely for one of the heart."
But why is it so hard to admit fault—and take the next step and apologize to the patient?
Some doctors, I'm sure, have been advised that saying sorry signals weakness or places physicians in untenable legal standing. Some may think it erodes their authority or professional "distance" from a patient.
Other reasons may lie within our psyches. Physicians can be seen as a select group with respect to personality types: It takes a great deal of determination and effort to become a physician and to spend a career in clinical medicine. Some of the characteristics required to accomplish all that is needed to practice and keep practicing are on the narcissistic end of the spectrum: self absorption and perhaps even selfishness. These characteristics can run counter to the principles of empathy and compassion, and that may be where the problem lies.
I've found that physicians rarely receive admonitions well and tend, as a whole, to be defensive. This can ring especially true in a hospital-based setting, where questions can be perceived as threatening or undermining. This defensive-mindedness, though, has changed a great deal over the past decade, with increased patient knowledge (via the Internet and direct-to-consumer advertising) and competitiveness within the medical profession for market share.
Defensiveness also seems less prominent in sports medicine, where the stronger personalities seem to be the athletes and coaches. Physicians tend to be very accommodating of requests from these groups. We receive questions all the time. We work with the knowledge that athletes often seek second opinions. Our work is scrutinized continuously, so we can't afford to be defensive about it.
I still see a strong need to admit fault and not hide our human side from our patients. It is simply the right thing to do medically, ethically, and morally. Also, I agree with Friedman that saying "I'm sorry" will help cement our relationship with our patient—and studies show that improved physician-patient relations help diminish malpractice lawsuits. Finally, according to Friedman, 16 states now offer legal immunity to doctors for their apologies to patients.
Perhaps Winston Churchill had it right when he wrote, "In the course of my life, I have often had to eat my words, and I must confess that I have always found it a wholesome diet."
P.S. At press time, The McGraw-Hill Companies announced the sale of the physician and sportsmedicine to the Vendome Group, LLC. For additional details, please visit www.physsportsmed.com.