Why It Matters
Dear IHI — I was shocked to read about a recent study that found most doctors would obscure their role in a medical error and avoid apologizing to patients. I realize that this is a long-standing cultural norm we have to overturn, but I also think we lack training in how to talk to patients after an adverse event. Do you have any tips for apologizing to patients? — TONGUE TIED
Dear TONGUE TIED —
Apologizing in the event of an error is a very difficult and emotional process for everyone. If an event occurs and you find yourself needing apologize to a patient, you need to learn to do it properly. A poorly executed apology — or an apology given for the wrong reasons — can do more harm than good.
Aaron Lazare, MD, describes the following four components of an apology:
- Acknowledgment
- Explanation
- Expression of remorse and humility
- Reparation
It's possible for an apology to be effective without every piece. But when an apology is ineffective, you can usually locate the issue in one or more of these four parts. A well-structured, conversational apology might sound like this:
- I and our organization feel responsible for what has happened, and I want to restore to you the support you deserve. [Acknowledgement]
- Let me tell you what I know happened, without speculation, and I promise to report more to you as it becomes known. It’s my fault that this happened because I made a mistake. [Explanation]
- Please know that I am very sorry. My goal is the same as yours: to make sure you get the best care possible. [Remorse]
- Let me tell you how we will continue to care for you and how our organization will learn from this event to make sure it doesn’t happen again. [Reparation]
I’ve found that giving clinicians a structure to follow helps keep them on point when talking to patients. It helps make their apology more complete and purposeful, and it makes a big impact on patients, even if they don’t appreciate it right away.
Another thing to consider is who delivers the apology.
The clinician responsible for the patient’s care is the most suitable person to apologize. We have heard from dozens of patients post-event that they wished they had discussed and heard the apology from the clinician involved instead of a third party.
Many times, it’s also helpful to bring an administrator to help answer non-clinical questions and social work and/or a chaplain to provide the emotional support for the patient and the family. No one likes admitting a mistake, but when done with empathy and candor, it can be therapeutic for all parties involved.
Lastly, I want to emphasize how important it is that these events turn into learning opportunities for the organization. We hear of organizations who have similar harms time and time again. If our organizations are not stopping to reflect on the system problems that are allowing recurring harms to our patients and families, we are failing to turn that traumatic event into an opportunity for positive change.
Warmly,
Jennifer Lenoci-Edwards, RN, MPH
Director of Patient Safety at IHI