The Medical Apology: Who and How?

Abstract

 

The concept of the medical apology and the surrounding debate over its place in clinical practice arose from accepting a truth that had long gone unacknowledged: Medicine is practiced and delivered by humans, and humans make mistakes; therefore, there are mistakes in medicine. This conversation about mistakes in healthcare began in 1994 with Lucian L. Leape's article “Error in Medicine.” On its heels came the Institute of Medicine's reports about medical error and patient safety. A vision for healthcare was born that differed greatly from how people had seen healthcare for centuries.

Michael S. Woods (2007) suggests that when something unexpected or untoward occurs in medicine, the act of apology is crucial for patients and families. Apology is also critical for healthcare providers. Saying “I'm sorry” comes naturally; people reflexively use the common phrase in the course of a normal day. However, practitioners and workers in healthcare have been effectively gagged by the culture of healthcare and kept from speaking these natural and healing words. “I'm sorry” can convey respect, regret, compassion, and caring. Yet we have forbidden such expressions in healthcare—a field in which people need to exchange them most.

Feature author Lucian L. Leape says that in cases of medical mistakes, patients' expectations are clear and simple: They expect acknowledgement that something has gone wrong and an explanation of how it happened. They want their caregivers to take responsibility, and they want a serious effort to ensure that such incidents will not happen again. But the majority of healthcare facilities still haven't implemented systems to make needed changes to day-to-day operations.