Admitting responsibility for mistakes

You should never be afraid to apologise if you have made a mistake, says MDU advisor Dr John Holden

This article echoes the MDU advice we first gave to members over 50 years ago.

If something goes wrong, patients are entitled to a prompt, sympathetic and above all truthful account of what has happened. It is usually appropriate to accompany this with an explanation by the clinician of what they propose to do to put the matter right, and an apology.

It is not always easy to admit to our mistakes, be they in our personal or professional lives. It is human nature to ask ourselves if we will be blamed, if the person we apologise to will be angry and if our career will suffer.

Yet, if something goes wrong in a patient’s care or treatment, apologising can actually have a positive impact. Saying ‘sorry’ and providing an explanation to a patient when a mistake has been made seldom does any harm and can often avoid a complaint altogether.

Legal liability
There is a long-standing myth that apologising is the same as admitting legal liability. In reality nothing could be further from the truth. GPs now have statutory legal protection when apologising to patients when things go wrong.

The Compensation Act 2006 received Royal Assent on 25 July 2006. Section 2 states: ‘An apology, an offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty.’

Offering an explanation and apology has also been a feature of GMC ethical guidance since 1998. The latest version of Good Medical Practice (2006) advises doctors: ‘If a patient under your care has suffered harm or distress you must act immediately to put matters right, if that is possible.

‘You should offer an apology and explain fully and promptly to the patient what has happened, and the likely short-term and long-term effects.’

Apologising is about having the conviction to deal with something that has gone wrong and acting with professionalism to acknowledge it.

MDU advice
The MDU’s advice to doctors about preventing a complaint escalating by giving an apology can be summarised as follows.

Take all expressions of dissatisfaction seriously, no matter how unimportant or benign they may seem.

Acknowledge the complaint. For example, if you arrive late for the start of a surgery, apologise to patients.

Take ownership of a complaint when it is directed at you. It is more likely that things may settle at an early stage if the clinician concerned is seen to take responsibility for an incident rather than handing it over to a manager or another colleague.

Learn from the complaint and take action to stop it happening again. Patients have a right to know about ‘hidden’ adverse incidents, for example, if a child has been given an incorrect vaccine. 

Consider reporting any adverse incident to the National Patient Safety Agency.

If a mistake has been made, patients are entitled to a prompt, sympathetic account and an apology when appropriate.

Follow any complaints procedure that applies to your practice.

Case example
A 55-year-old woman with jaundice saw a GP registrar. After taking a full history and performing an examination the GP registrar recommended to the patient that she have some blood tests and an urgent ultrasound scan of her liver, to which she agreed. A week later the doctor reviewed the blood test results and realised that he had not arranged the scan.

After sending the scan request, the GP registrar rang the patient to explain that he had initially overlooked this aspect of the investigation and apologised for the oversight and the consequent short delay in the investigations.

The patient expressed her thanks to the doctor for his trouble in contacting her, and the GP registrar noted the incident fully in the medical record. Fortunately no harm ensued from the delay and the doctor and his patient maintained a good relationship. 

Dr Holden is a medico-legal adviser at the MDU 

Learning points
How best to deal with mistakes

  • Acknowledge any complaints that patients make, no matter how trivial they seem.
  • Take responsibility and own a complaint if it is directed at you.
  • Learn from your mistakes and how to stop them happening again.
  • Inform patients of any adverse incidents.
  • Provide patients with a prompt sympathetic account when you make a mistake and apologise if it is appropriate.
  • Follow your practice’s complaints procedure.

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