The Healing Power of a Doctor’s Apology

More than a bandaid, a sincere apology made by a medical professional to a patient after a making mistake can make a world of difference in the relationship.

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In an era marked by division and mistrust, the simple act of admitting a mistake remains a powerful tool for healing—not just in everyday life but in the high-stakes world of medicine.

Dr. Kate McLean encountered her own fallibility during a seemingly routine surgery on an older woman, which nearly ended tragically due to unexpected complications.

During the surgery, an overlooked enlarged liver caused a life-threatening situation when a surgical instrument was inserted. The medical team’s swift response stabilized the patient, preventing a tragedy.

After the incident, Dr. McLean opted for transparency, admitting the oversight to her patient and apologizing for the error.

“I had already begun to build a bond with my patient, though our relationship was brief,” Dr. McLean, a board-certified obstetrician-gynecologist with a master’s in public health, told The Epoch Times. “I lacked formal training in apologizing to patients, but instinctively, I knew it was the right thing to do.”

Contrary to fears of litigation or professional censure, the patient responded with understanding and forgiveness, appreciating Dr. McLean’s honesty and care.

Dr. McLean’s apology profoundly impacted her professional outlook, reinforcing her belief that openly acknowledging errors can enhance patient trust and improve care outcomes.

The Infallible Doctor

Apologies are rare in the traditionally stoic world of medicine. The culture within many health care settings discourages admissions of fault.

“Perfectionism is common among physicians and within the culture of medicine,” Dr. Zeev Kain, a Yale- and Harvard-trained physician-scientist, noted in a 2022 study.

“We are not allowed to make mistakes within the context of medicine,” Dr. Kain explained to The Epoch Times. “This trait of perfectionism is encouraged from the start.” Such pressure causes psychological stress for doctors and fosters a reluctance to disclose errors.

Echoing this sentiment, Dr. Zed Zha, a physician and writer, remarked to The Epoch Times, “While perfectionism is the goal in medicine, it is entirely unattainable.”

Medical training often prioritizes infallibility and decisive action, a focus that can hinder open discussions about mistakes. Studies reveal that only 43 percent of medical trainees would “definitely” admit to a mistake. This likelihood decreases as their training progresses, leading to less frequent and less candid apologies.

Litigation fears also sustain this culture. An American Medical Association analysis shows that nearly half of all physicians over 54 have faced at least one lawsuit, leading to defensive medical practices. This defensiveness often conflicts with open communication and apologies as health care providers worry about potential legal repercussions from admitting faults.

Navigating Medical Risks and Human Fallibility

The widespread belief that medical professionals must be flawless masks a critical truth: Doctors are human and make errors. Idealizing physicians as perfect imposes a significant psychological burden on them and amplifies the stress associated with inevitable mistakes.

“Doctors are human, and humans make mistakes,” Dr. McLean noted, highlighting a troubling issue in health care. The National Academy of Medicine reports that preventable medical errors cause about 150,000 deaths each year in the United States.

Inherently, health care is laden with risks and uncertainties. Every medical procedure, whether routine or complex, involves potential complications. This high-stakes nature of medical care implies that it is impossible to eliminate errors completely.

The Power of Apologies

The American Medical Association (AMA) requires physicians to disclose medical errors, stating that “open communication is fundamental to the trust that underlies the patient-physician relationship.” The AMA’s code of medical ethics underscores the dual obligations of honesty and promoting patient welfare and safety.

Ethical guidelines consider the disclosure of medical errors a moral imperative, supporting the dignity of the medical profession and the patient’s right to understand their care. Based on the principle of autonomy, this ensures that patients can make informed decisions about their health care.

“Consideration for patient autonomy suggests that patients have a right to make their own health care decisions, which requires knowledge of events that have affected their health,” psychiatrists Nina Ross and William Newman explain in a commentary.

Professor Richard Frankel, who specializes in clinician-patient communication, underscores the significant effects of sincere apologies in health care. “Research in the VA [veteran’s affairs] medical system has shown that a sincere apology from a physician or any health professional who has made an error not only reduces the probability of a malpractice suit being brought but also serves to lessen the emotional and psychological impact on both sides of the stethoscope,” he told The Epoch Times.

Studies indicate that when doctors make medical errors, they frequently experience significant emotional distress, which can lead to depression or doubts about their professional competence. A heartfelt apology can mitigate these effects, helping physicians manage their emotional responses and maintain professional integrity.

“There is no question that a sincere apology can act to restore trust and heal a rupture in the provider-patient relationship.” Dr. Frankel stated.

Humanizing Health Care Through Apologies

Early in her career, Dr. Zha incorrectly diagnosed a fracture in a young patient’s knee. Subsequent reviews and consultations identified the supposed fracture as a normal variant for teenagers. Dr. Zha personally apologized to the patient’s mother for the error, showcasing a degree of humility seldom observed in the medical profession.

“Well. It’s not a fracture. I was wrong about the diagnosis. And … I … I am sorry about the additional trip and X-ray you had to do,” she recalled in her blog. The patient’s mother met this admission with understanding and forgiveness, strengthening their trust.

“By saying ‘I am sorry. I was wrong. And I wish to not do it again,’ I allowed the recipients to see me as an equal, a person whose pride comes secondary to her ethics, and a fellow human they can relate to,” Dr. Zha explained.

“Apologies help to dismantle the hierarchy in medicine,” she informed The Epoch Times. She contends that in a field where doctors are perceived as infallible, offering apologies can level the playing field and address the inherent imbalance in the doctor-patient relationship.

Apology Laws in Medicine

Apology laws empower health care professionals to express regret for errors without fear that their statements will be used against them in malpractice lawsuits. Rooted in the belief that apologies from doctors reduce the likelihood of litigation and encourage amicable dispute resolution, these laws are now enacted in 39 states, though the level of protection they offer varies significantly.

A 2019 study analyzing malpractice claims against 9,000 U.S. medical providers found mixed effects of apology laws. While surgeons saw no change in the frequency or progression of claims, non-surgeons in states with these laws experienced a 46 percent increase in claims escalating to lawsuits. The study suggests the increase in claims among non-surgeons may stem from the more subtle nature of non-surgical errors, which become more apparent to patients after an apology.

Moreover, payouts for lawsuits involving non-surgeons more than doubled in states with apology laws. These findings imply that apologies, while meant to mitigate disputes, may instead highlight errors to patients, thereby increasing the likelihood of claims.

“The idea is simply that if providers could just say they’re sorry, that’s what patients really want. They really don’t care about punishing the doctor in a financial context, they care about having them express remorse,” said Larry Van Horn, a researcher and professor at Vanderbilt’s Owen Graduate School of Management in a press release. “But what we find is that no, people sue for money. ‘Sorry’ is not enough.”

Some research suggests that apologies do influence financial outcomes in malpractice cases. An analysis of state-level apology laws revealed that apologies could decrease average malpractice payouts by $32,000. The effectiveness of these apologies varies, achieving the most significant reductions in cases involving obstetrics, anesthesia, infant care, and mismanagement or diagnostic errors.

Hospitals Address Apologies

The implementation of apology laws has spurred hospitals to adopt more transparent communication policies. Medical facilities are increasingly implementing disclosure protocols and communication and resolution programs (CRP). These programs are designed to ensure that patients receive apologies and explanations after adverse events—they often include investigations and, when appropriate, offers of compensation.

Tennessee’s Erlanger Health System experienced notable improvements after implementing a CRP in 2009, transitioning from a “deny and defend” strategy to a more transparent approach to managing medical errors.

A 2018 study highlighted that this program significantly reduced new claims per 1,000 hospital admissions from 1.07 to 0.36. Additionally, it decreased defense and total liability costs, and the average time to resolve claims was more than halved—from 17 months to eight months. Notably, 43 percent of medical error cases were resolved simply with an apology.

Integrating Apologies Into Medical Training and Culture

Dr. Kain notes the challenges in legislating behavior through apology laws and hospital mandates, suggesting that genuine change in a doctor’s willingness to apologize must originate internally rather than being imposed externally.

Transforming the culture of medicine starts early, even before students enroll in medical school. “When selecting individuals for medical school, we often prioritize grades and achievements over communication skills. Yet, especially in fields like obstetrics, communication is crucial to outcomes,” Dr. McLean explains.

Once admitted to medical school, formal training in error disclosure remains rare. However, studies indicate this type of training significantly increases the probability that medical professionals will openly discuss mistakes.

Research involving third-year medical students at Indiana University School of Medicine highlights the necessity of integrating these skills into medical education. The study found that most apologies observed by students were incomplete, typically missing a sincere acknowledgment of harm or an offer of amends. Students learned about apologies primarily by observing their senior colleagues, who may not always demonstrate best practices.

Many students reported feeling distressed by their instructors’ inadequate apologies, and some felt compelled to apologize for their superiors’ shortcomings themselves. Dr. Frankel emphasized the urgent need for change, stating, “We concluded that since modeling is such an important part of medical education, faculty development in how to offer genuine apologies would be useful for teaching future generations of healthcare professionals.”

Echoing Dr. Frankel’s call for educational reform, Dr. McLean advocates for a broader systemic change in medical training. “Physicians should be evaluated on their communication skills with the same rigor as other medical competencies,” she argues, highlighting the need to prioritize communication as a core skill in the medical field.

The Anatomy of an Effective Apology

In the medical field, a genuine apology is more than mere words—it is a vital process that promotes healing and trust after errors. The nature of the apology is crucial.

“A non-apology is worse than not apologizing at all,” explains Dr. Zha. Non-apologies are statements that mimic an apology without honestly acknowledging wrongdoing or expressing sincere regret, such as saying, “I’m sorry you feel that way.” Such remarks typically leave individuals feeling invalidated, blamed, and disrespected.

Dr. Richard Frankel outlines the four key elements that make an apology sincere and effective:

1. Acknowledgement: This involves taking full responsibility for one’s actions and clearly owning up to mistakes. It’s the foundation of rebuilding trust.
2. Explanation: Provide a clear and honest account of what happened, why it occurred, and how, without deflecting blame or being defensive.
3. Remorse: Showing true regret for the incident and a commitment to preventing future occurrences.
4. Reparation: Making amends through financial compensation, emotional support, or other suitable means to rectify the damage caused.

Dr. Frankel emphasizes that the quality of an apology matters more than its timing, though timing should not be overlooked. “In my own experience, I have found that the earlier I make an apology, the more likely it is to be accepted.” He notes that while he prefers a prompt approach, some colleagues find that waiting to gauge the situation can also be effective.

“If we want better patient care, we have to value humility more than we value perfection,” Dr. McLean concluded.