Repeat After Me: I'm Sorry

"I'm sorry," the doctor said to the patient in the hospital bed. "It's my fault you have to stay another couple of days. I didn't monitor you carefully enough after starting you on that new drug, and you had a severe allergic reaction." A doctor said he was sorry? The patient faints.

That little scene was made up, but something like it (minus the fainting patient) should be enacted in hospitals and doctors' offices routinely. Physicians have been hearing for some time now that apologizing when they err is almost always the right thing to do. Patients are surprisingly inclined to be forgiving when doctors admit, in effect, that they are human and sometimes screw up. Hospitals whose administrators urge physicians to be forthright usually see legal bills fall, not rise. And this approach focuses attention on the system that permitted the error to get through rather than placing blame on the doctor who committed it. Yet apologies are still the exception, not the rule.

Doctors say they believe in telling a patient when a harmful error is made. The latest evidence comes in a survey conducted at four teaching hospitals and just published online in the Journal of General Internal Medicine. Researchers reported that overwhelming percentages of faculty and residents–as high as 95 percent of them–agreed with statements such as: "Disclosing medical errors is the right thing to do even if it comes at a significant personal cost (e.g., harms my reputation or increases my malpractice risk)" and "It is important for me to tell my patients about errors I have made because that is how I would want to be treated if I were a patient."

Now, these doctors were not mulling over an issue that was too abstract or hypothetical to resonate. Eighty percent of the faculty physicians said they had made a minor mistake during their career that prolonged a patient's treatment or caused discomfort, and nearly 20 percent had made a major one that resulted in a patient's disability or death.

Yet almost one third of the doctors who admitted to making a minor mistake and nearly half of those who had committed a serious one also reported that they hadn't told the patient or the patient's family about it. These are the same physicians who claimed in a different part of the survey that of course they believe in confessing. It is the right thing to do. Patients value it.

So why aren't they doing it?