The Hippocratic Oath
Chances are if you’re reading this article, you have most likely heard the expression, “First, do no harm” and have maybe even dedicated your life’s work to upholding these words.
It derives from the Latin phrase, “primum non nocere” or “primum nil nocere” and is commonly known in the medical field, since it is a basic principle taught in healthcare-providing classes. (1)
Although the exact expression cannot be found verbatim in the Hippocratic Oath, it conveys the highest level of standards that every healthcare worker vows to uphold. For some, it’s interpreted as, “don’t make a mistake.” No pressure, right? Wrong! I’m not a physician or even a healthcare worker, but I am responsible for the care of four small humans and that’s enough pressure to break me most days! I’m constantly making mistakes and praying they do not negatively impact my children. I can only imagine the weight healthcare providers carry with the pressure to perform.
In the article titled, “Medical Error Prevention,” published on May fifth of this year, Thomas L. Rodziewicz and John E. Hipskind articulates this pressure well by writing,
“Health care professionals experience profound psychological effects such as anger, guilt, inadequacy, depression, and suicide due to real or perceived errors. The threat of impending legal action may compound these feelings. This can also lead to loss of clinical confidence. Clinicians equate errors with failure, with a breach of public trust, and with harming patients despite their mandate to ‘first do no harm.’”(2)
Wow, that’s heavy. I make this point not to be dramatic, but to paint the scene – maybe even the reality for some readers.
Identification and Management
To make matters more confusing, the topic of medical errors and whether to apologize for them or not has dramatically changed in the last forty years. In his article, “Apologies, Properly Made, Go Far in Maintaining Doctor-Patient Relationships,” David J. Alfandre, MD, MSPH writes on the matter, “Such admissions have evolved from a topic that was rarely acknowledged in healthcare to one where identification and management are central to the ongoing safe provision of care.” (3)
Doctors were once advised not to apologize, or even express sympathy when a mistake was made, for fear that something they said might be used against them in the event of a malpractice suit.
Thankfully, however, times are changing. According to an article titled, “Should Doctors Apologize for Mistakes?”, thirty-nine states and the District of Columbia have enacted “I’m Sorry” laws since 2018, prohibiting a doctor’s apology or act of sympathy to be used as an admission of guilt. (4)
I understand the hesitancy to apologize when a mistake is made, but I would argue it’s actually what patients desire.
Provider Transparency and Patient Engagement
As we’ve discussed in the previous weeks of this blog series, patient behavior and expectations are rapidly evolving, and consequently, so are patient desires regarding healthcare.
In 2020 and beyond, patients want to be involved in the healthcare decision-making process. This means being informed of any mistakes that might have taken place.
Going back to the previously mentioned article, David J. Alfandre, MD, MSPH writes, “The expectation among patients now is their physicians will be honest with them about information relevant to their care.” (3)
This type of transparency will increase the level of trust between the patient and the provider. It helps the patient to feel heard, valued, cared for, and respected. It also alleviates any mystery or confusion on the patient’s part. Again, modern-day patients have limitless amounts of information at the click of a button. They are not comfortable with being uninformed and will often dig until they arrive at the answers they desire, especially when it comes to their health.
Fear of Litigation
Many physicians fear the potential of litigation if they admit their mistakes and offer an apology; however, studies show that a prompt recognition and proper management of the error can lessen the consequences.
On March twelfth of 2017, The Washington Post released an article illustrating two very different scenarios in which provider mistakes were made and the patients suffered as a result.
The first patient was met with vague answers to her healthcare concerns and consequently, she filed suit and was committed to finding the truth at all costs.
The second patient, however, was met with an explanation and apology from his physician. His case was resolved in a peaceful manner and his attorneys negotiated a settlement without litigation. (5)
The National Law Review published an article titled, “You Had Me At ‘I’m Sorry’: The Impact of Physicians’ Apologies on Medical Malpractice Litigation,” and explains, “Apologies may decrease feelings of frustration and anger that drive some plaintiffs to file lawsuits.” (6)
Make a Plan
Planning for medical errors in a way that combines provider transparency and patient engagement will decrease hostile reactions and defuse potential blowups.
In 2009, the Erlanger Health System decided to make a plan for the inevitable issue of how to handle medical errors, and they instituted a “collaborative communication resolution program.”
By 2018, the hospital system was able to report, “Of the thirty-five percent of adverse events found to involve medical error, forty-three percent of claims were resolved with apology alone.” (7)
In an article titled, “What Happened to Saying ‘I’m Sorry’ after Medical Mistakes?”, lawyers Rex Baker and Caroline Gilchrist write, “Contrary to what doctors, hospitals and healthcare providers have believed for many years, when doctors offer a sincere apology, it potentially reduces the risk of liability and offers both medical professionals and patients some closure.” (8)
Mistakes are inevitable. As a patient, I would much rather trust my healthcare to a practice that embraces and plans for this reality, rather than runs from it.
An Effective Apology
In conclusion, I’d like to point you back to the article “Apologies, Properly Made, Go Far in Maintaining Doctor-Patient Relationships.”
It states, “Beyond simply saying, ‘I’m sorry,’ there are 3 critical components of an effective apology, and the lack of any one of these can lead to a ‘failed’ apology, exacerbating the offense.
The first element is a genuine acknowledgment and responsibility for the offense.
The second is an expression of remorse, humility, and regret for the offense.
The third is an attempt to provide reparations to help heal the relationship.” (3)
The art of apologizing seems to be diminishing as the world seems to be busy looking for every opportunity to pick up offense, defend its position, or deny its wrongdoing.
As a patient, and a fellow imperfect human being, I urge you to admit when you’re in error and invite your patients into an honest conversation regarding their healthcare and wellness plan.
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Jerry L. Stone