Financial Times Weekend Magazine | July 1, 2011

By Kiran Gupta

Mistakes in hospitals happen, perhaps more frequently than we might think. Some are relatively trivial, others can lead to serious harm. The ability to say sorry when things go wrong is key to any relationship, including that between patient and doctor. But in America, we have long been advised not to apologize to our patients. It could be used to build a malpractice case against us.

Fear of malpractice is palpable in everyday medical practice. Studies suggest this may increase healthcare costs by causing us to practice “defensive medicine” (performing unnecessary diagnostic tests or avoiding high-risk but necessary procedures in order to avoid being sued).

This fear extends to apologizing to patients. Late one Friday, I was on call on the oncology service. Mr S had left the hospital about a week ago, but he was already back, having woken that morning with a high fever. As he had no other symptoms, I started him on multiple antibiotics.

Around midnight, my pager went off as I lay down for a nap. “Mr S going for CT scan.” It was from his nurse. Confused, I double-checked my orders, thinking I might have ordered the CT by mistake. Nope. I called the nurse back and reiterated that he was not to get a CT scan that night. Around 1am, my pager went off again. “Please place order in computer. Have given Mr S Readi-Cat for CT scan.” I jumped out of bed, hoping the page was a mistake. Readi-Cat, or barium sulfate, is given to detect problems in the abdomen. Side effects can include stomach cramps, diarrhea, nausea and vomiting as well as hives, itching and breathing difficulty.

The flustered nurse told me that the radiologist had called her repeatedly to say that room 59 (Mr S) should drink the Readi-Cat. Rather than confirming which patient the radiologist was actually referring to (it turned out to be room 58), she had given it to him.

Fortunately Mr S was not allergic to Readi-Cat. But he was my patient and I had to apologize. I sat down next to his bed. “Mr S, I’m sorry to wake you, but I have something I need to tell you.” He looked at me and smiled. “We gave you Readi-Cat by mistake. It may have caused you discomfort. You should not have had to drink that and we are sorry.”

My heart was pounding. What if he decided to focus on the implications of this mistake?

“Well, I’ll tell you one thing,” he said. “It tasted awful. But, I’m glad I don’t have to get the CT because I want to sleep.”

Back in the call room, I sat down to prepare an incident report. As I typed, I thought about what I had said to Mr S. In most work settings, mistakes are accepted and apologies to a client or customer naturally follow. Yet medicine is held to a higher standard. The stakes are high when it comes to life and death. But the pressure we face to provide perfection could lead us not to acknowledge errors.

Recently, several states have passed “apology laws”, making physicians’ apologies toward a patient inadmissible in court proceedings. These laws undoubtedly improve patient-doctor communication and may even reduce malpractice liability costs. Furthermore, the ability to acknowledge mistakes may help prevent them in the future.

Mr S deserved to know the truth and I wanted him to realize that I was truly sorry. Otherwise, how could I look him in the eye the next morning? Most of us jump at that chance to say, “I’m sorry,” if we hurt someone we care about. Allowing doctors to do the same to patients helps restore trust to this privileged relationship.

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