Dr Michael Devlin
Being upfront with patients and offering a proper apology when necessary can go a long way with unhappy patients, as Dr Mike Devlin explains.
There are some things in professional life that we can't always prepare for, and one of them is what to do when things go wrong. In medical school you may have found the focus was on the positives - what you had to do to make patients better, or at the very least alleviate their symptoms.
Media portrayals of doctors perhaps don't help either. Their ability to cut through confusing and sometimes contradictory symptoms, signs and test results to arrive at a diagnosis that hadn't occurred to any of their colleagues is uncanny, but it is hardly the reality of real-life clinical practice.
Fast forward 20 years and you'll find few doctors who can't tell you about the anxiety, nausea and fear that resulted from the realisation that something they had done (or failed to do) harmed a patient. It's the antithesis of what medicine is concerned with. But perhaps it shouldn't be seen in that way.
A different approach
Perhaps the essential quality of medicine is maintaining the trust of patients by being honest and candid, and apologising. And it's the apology that often makes us stop and think. Wouldn't it be an admission of liability on our part?
Time now to dispel some myths and (hopefully) reassure you that a full and frank apology is the right thing to do. Firstly, it is not an admission of liability, and the law - specifically section 2 of the Compensation Act - recognises this.
Secondly, your ethical duty of candour will generally require that you apologise to a patient for something that has gone wrong and caused them harm or distress.
Thirdly, an apology, freely given with sincerity, can be a potent way of maintaining a patient's trust. It may not guarantee that a complaint will not follow, but you can rest assured it reduces the risk.
Imagine this simple, but common scenario.
You're trying to gain experience in venous cannulation, and a patient agrees (with a registrar supervising) that you can insert one in their hand. Unfortunately, you fail. Bravely, the patient agrees that you can try on the other hand. The same thing happens - failure.
The registrar then takes over and makes it look so simple, with the cannula being sited with apparent ease. You see the patient the next day and their hands are bruised from your failed attempts at cannulation.
Should you apologise?
Of course you should. The practical guidance that follows may make it easier to do so.
Practically speaking, there are some points that are worth bearing in mind.
- Speak as you would in a natural conversation. Talk in the first person. 'I'm very sorry my cannulation attempts left you with so much bruising,' will sound more sincere and less defensive than, 'I wish to express regret that…'
- Set the scene. It often helps to explain (as fully as you can and bearing in mind that further investigation into what happened may be necessary) exactly what occurred. In the scenario above, you could explain that the skill is not an easy one to master - it needs to be practised, and you're very grateful for the patient's understanding in letting you try. Once there is context, an apology can naturally flow.
- Think about privacy and body language. Even if you're saying the right words, if you're standing at the end of the patient's bed, arms folded and surrounded by the whole medical firm, it may not come across like an apology at all. Take some time, choose a quiet moment and use open body language, perhaps just one other colleague there, such as the registrar who supervised you the day before.
- Remember, a meaningful apology is a dialogue. Sometimes patients would prefer not to hear from the person involved in the incident, while others may prefer to meet them again. It is also important to allow the patient a chance to ask questions. Be receptive to the patient's wishes and be prepared to respond.
- Take it one step at a time. Doctors often worry that an apology may be harmful if a complaint or claim follows later. But the MDU finds the opposite tends to be true. The reasons patients make a complaint or bring a claim are complex, but a culture of openness, together with a sincere, timely apology may go some way to preventing them in the first place or leading to an earlier resolution.
Dr Michael Devlin
Head of professional standards and liaison
Mike was an MDU medico-legal adviser for 15 years, latterly as head of medico-legal services, before taking up the new role of head of professional standards and liaison. He sat on the FFLM’s academic committee and was previously treasurer, and an examiner for the MFFLM. He has published widely on medico-legal matters, and has significant experience in teaching and assessing knowledge in medico-legal subjects.
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