Apology in cases of medical error disclosure: Thoughts based on a preliminary study

Abstract

BackgroundDisclosing medical errors is considered necessary by patients, ethicists, and health care professionals. Literature insists on the framing of this disclosure and describes the apology as appropriate and necessary. However, this policy seems difficult to put into practice. Few works have explored the function and meaning of the apology.ObjectiveThe aim of this study was to explore the role ascribed to apology in communication between healthcare professionals and patients when disclosing a medical error, and to discuss these findings using a linguistic and philosophical perspective.MethodsQualitative exploratory study, based on face-to-face semi-structured interviews, with seven physicians in a neonatal unit in France. Discourse analysis.ResultsFour themes emerged. Difference between apology in everyday life and in the medical encounter; place of the apology in the process of disclosure together with explanations, regrets, empathy and ways to avoid repeating the error; effects of the apology were to allow the patient-physician relationship undermined by the error, to be maintained, responsibility to be accepted, the first steps towards forgiveness to be taken, and a less hierarchical doctor-patient relationship to be created; ways of expressing apology (“I am sorry”) reflected regrets and empathy more than an explicit apology.ConclusionThis study highlights how the act of apology can be seen as a “language act” as described by philosophers Austin and Searle, and how it functions as a technique for making amends following a wrongdoing and as an action undertaken in order that neither party should lose face, thus echoing the sociologist Goffmann’s interaction theory. This interpretation also accords with the views of Lazare, for whom the function of apology is a restoration of dignity after the humiliation of the error. This approach to the apology illustrates how meaning and impact of real-life language acts can be clarified by philosophical and sociological ideas.

Why Are Patients Unhappy with Their Healthcare? A Romanian Physicians’ Perspective

“…It is essential, correct, and moral for physicians to communicate when an incident of a medical act occurs, the patients having the right to receive explanations for the damage they suffered, regardless of the circumstances in which it occurred [ 31 , 32 ]. There are studies showing that early [ 33 ] and complete [ 33 , 34 ] disclosure of incidents increases patients’ confidence in their physicians, helps them make decisions about the next steps in treatment, overcomes emotional trauma more easily [ 31 ], and extinguishes the desire to complain [ 33 ].…”

Ethical Tenets of PRN Medicines Management in Healthcare Settings: A Clinical Perspective

“…However, it can have negative implications for patient safety culture and creates changes in harmful medication routines [ 78 , 79 , 80 ]. Additionally, it serves nonmaleficence and beneficence to the extent that it prevents further harm to the patient or to other patients who may request the same medication [ 81 ] and can preserve and restore the patient’s feeling of dignity and respect [ 82 , 83 ]. Deprescribing as the process of withdrawal of inappropriate medications also can prevent the patient’s exposure to probably inappropriate medications [ 43 , 84 ].…”

Whose experience is it anyway? Toward a constructive engagement of tensions in patient-centered health care

“…However, this approach misses opportunities to decrease risk of litigation, increase service recovery and learning, and, in turn, create a more positive patient experience via a more complete apology. Such an apology comprises three functions – offering explanations or acknowledgement of responsibility, expressing regret and empathy and seeking forgiveness or redressing the patient–physician relationship (Dahan et al , 2017). As such, apologizing could also address both patient and physician emotional distress after an error occurs, as it reduces the need to engage in taxing emotional labor and is consistent with the patient's perceived psychological contract (where an apology is expected).…”

“…laws) to necessitate prompt disclosure of harmful medical errors and to inform patients about unanticipated care outcomes (Liang, 2002). In practice, apology laws (which are protective measures designed to mitigate doctors' perceived risk and fear that their admission of error increases the probability of a malpractice suit and financial settlements) tend to vary between states (within the USA) and among countries (Dahan et al , 2017).…”