Examining Your Role as a Hospitalist: When Do You Need to Apologize to Patients?

Perhaps Elton John was onto something when he crooned that, “sorry seems to be the hardest word.” For decades, apologies have not been the standard response when a medical error or breakdown of patient care occurs during a procedure or hospitalization. However, medical errors (both small and large) are a regular occurrence in hospitals, and the consequences of those errors can harm patients or leave them feeling disrespected and devalued.

Knowing when and how to issue an apology is one way hospitalists can build and maintain a trusting, respectful and valuable relationship with the patients under their care. Let’s explore the role apologies play in the health care setting.

Why Is It So Hard to Apologize?

At some point, we’ve all struggled to apologize to friends and loved ones in our personal lives, even when an apology is warranted. That struggle is amplified when we’re faced with making an apology in our professional lives. But there’s more than just pride or defensiveness holding us back.

As a dedicated hospitalist, you feel the burden of responsibility for the patients in your care. When something goes wrong, you may feel intense self-shame and disappointment that you potentially harmed someone under your watch. You may worry that patients will lose confidence and respect for you or view you as incompetent if you confess to making a mistake. After you’ve spent years perfecting your craft, it is understandably difficult to own up to mistakes.

Additionally, many hospitalists hold their tongues because they believe admitting to an error will leave them vulnerable to disciplinary action or a malpractice suit. Today, multiple states – including the State of Florida – have “apology laws” that allow medical professionals to apologize, express sympathy or offer condolences without the apology being used against them in court.

When Is It Appropriate to Say, “I’m Sorry?”

When it comes to breakdowns in care, an apology can be appropriate in more scenarios than you may think. While many patients and their families report at least one breakdown in care during a hospitalization, the majority of problems aren’t dire medical errors. Long wait times in the ER or to see a specialist, a late dinner tray delivered ice cold, perceived rudeness from a nurse or doctor – these are all situations where an apology can help reduce a patient’s stress or fear and solidify a caring and trusting relationship with you.

You can – and should – give a meaningful apology without taking responsibility for events out of your control. Your patients are ill, sleeping in unfamiliar beds, and worried about their health and mortality. What they want above all is to be treated with respect and care during an overwhelming and stressful time. Expressing regret and concern that an oversight or error has caused them harm helps your patients feel understood and validated.

In cases where you did commit an error, or your actions had an unexpected outcome, an apology is always appropriate. Saying “I’m sorry” and explaining exactly what happened can diffuse a tense situation and help maintain open dialogue, trust and communication between you and your patient.

How to Apologize Effectively

The most important aspect of an effective apology is active listening. The first thing you should do when you enter a room with an upset patient and family is sit down. The act of sitting down indicates that you’re ready and willing to take the necessary time in your day to listen to the patient’s grievances.

A sincere and effective apology will:

• Provide a thorough and transparent explanation for the error that occurred
• Demonstrate empathy by recognizing how the error caused harm to the patient
• Express regret for both the error and the negative outcome
• Offer a solution (if there is one)
• Acknowledge areas for growth and improvement in the future

Remember that not every patient issue will have a solution – unfortunately, there’s not much you can do about long wait times in the ER or slow service at mealtimes. However, not all patients or their families expect a solution to every single care problem. They simply want to feel seen and validated.

Most importantly, prepare and deliver your apology with thoughtfulness and sincerity. Your patients and their loved ones will absolutely be able to tell if you’re not paying attention, aren’t sincere, or getting defensive when the patient tries to explain an issue.

The Healing Power of Apologies

An apology may not be able to correct an error or prevent errors from occurring again, but it does have significant healing powers. An apology can restore the trusting relationship between you and your patient. It demonstrates your ability to empathize with the pain, frustration and fears your patients are facing during a hospitalization. It demonstrates your willingness to humble your pride and accept responsibility for your actions as a caregiver. It demonstrates your respect for patients by acknowledging that they deserve quality care and attention.

In cases of non-egregious errors or a breakdown in care, failing to issue an apology can erode a patient’s trust in you or make them believe you’re not concerned with their health and well-being. In cases of egregious errors, denying responsibility for a mistake could leave you and your hospital vulnerable to a malpractice lawsuit.

We’re not suggesting that an apology is a safeguard against disciplinary, reputational or legal consequences, especially in cases of significant or fatal errors, but failing to acknowledge responsibility when something goes wrong will only lead to more justifiable anger from patients and their families.

Contact Advanced Care Hospitalists to Learn More

ACH is a Lakeland-based hospitalist group providing comprehensive patient care in community hospitals across Central Florida. If you are interested in learning more about our programs, services, providers or becoming a partner facility, please call us at 863-816-5884 or fill out a contact form online.