Saying sorry when things go wrong

A sincere apology when things go wrong can help prevent patient complaints from escalating explains Dr Greg Dollman from the MDDUS.

Sorry might seem like the hardest word but there are times when a doctor should apologise to a patient - a sincere apology is often all a patient wants to resolve a complaint.

A recent Parliamentary and Health Service Ombudsman report revealed that an inadequate apology was the most common reason hospital complaints in England were referred to them, accounting for 34% of all secondary care complaints investigated in 2014/15.

Receiving a complaint from a patient is the most common reason doctors seek advice from MDDUS and accounts for around a fifth of all the contacts we receive. Many of these complaints can be dealt with by way of an apology and an honest and direct explanation.

Is an apology an admission of guilt?

Some doctors might be reluctant to apologise believing that saying sorry is an admission of guilt or liability in any potential negligence claim. This is not the case, as stipulated in various authorities for the different home countries.

Offering an apology is not a sign of weakness. In fact, at times not only is it the right thing to do, it is also a doctor’s duty.

There is both professional and statutory guidance to direct a doctor when considering when and how to apologise. The GMC’s Good Medical Practice provides general guidance to doctors in regards to the professional conduct expected of them.

This includes saying sorry when appropriate and providing a full and timely explanation in an appropriate manner to the individual’s concerns. The NHS complaints procedure imposes a similar legal obligation on doctors.

How to apologise

It can be stressful for doctors receiving complaints, but they should avoid acting defensively. An open and honest approach can help resolve complaints at the earliest possible stage.

Professionalism requires doctors to be honest and responsible and act with integrity. Doctors should show empathy and respond objectively after consideration of the patient’s point of view.

Where doctors can identify any failings in their care of the patient, then a sincere expression of sorrow or regret should be offered at the earliest opportunity as well as an explanation as to what went wrong.

Doctors should use appropriate language and tone and the use of medical jargon should be avoided.

In our experience, most patients who complain do not wish to pursue long and drawn-out formal complaints. Often just listening and understanding a patient’s concerns can defuse a situation.

Even if the doctor does not believe a mistake has been made, it is still possible to adopt a conciliatory tone and express regret that the patient is dissatisfied.

Each patient complaint is different so advice will vary depending on circumstances but there can be no harm in a sincere expression of regret for the patient’s dissatisfaction. Patients want to know that their doctor cares and understands their concerns. They want their doctor to be honest and responsible.

Learn from complaints

It is also important to try to learn from complaints, reflecting on what has happened and identifying any changes in individual practice or systems that may be required.

Changes of this kind may also be shared with the complainant to demonstrate that the matter has been taken seriously. Patient safety can be improved if you have a system in place to review and learn from mistakes.

The GMC’s recent Openness and honesty when things go wrong: the professional duty of candour provides further guidance to doctors about saying sorry. Along with advice highlighted in this article, it also reminds doctors not to be formulaic in their responses, as an apology has value only if it is genuine.

Key points
  • Saying sorry is not an admission of guilt or liability
  • Doctors must consider their professional and legal obligation to offer an apology
  • A direct and honest explanation can help ease patient concerns
  • Often a sincere apology may prevent a complaint escalating into a legal claim
  • Doctors should avoid acting defensively when a mistake has been made
  • Explain to patients what went wrong and listen to their concerns
  • Dr Greg Dollman is a medical adviser for MDDUS

Photo: iStock

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