Being a Doctor Means Having to Say You're Sorry

Laurie Barclay, MD

Feb. 25, 2003 — Neither doctors nor patients get the proper emotional support after being involved in a medical error, according to the results of a focus group analysis reported in the Feb. 26 issue of The Journal of the American Medical Association. The investigators suggest that doctors should make more of an effort to apologize to their patients, in addition to providing them with appropriate information regarding the nature and cause of the error.

"Health care institutions nationwide are developing ambitious programs to prevent medical errors," write Thomas G. Gallagher, MD, from the University of Washington School of Medicine in Seattle, and colleagues. "Yet, despite our best efforts, medical errors will inevitably occur."

Factors preventing full disclosure of medical errors to patients by physicians may include fear of a malpractice suit, concern about professional reputation, and feeling awkward or uncomfortable.

Of 13 focus groups held between April and June 2002, six involved only patients, four groups involved only physicians, and three groups included both patients and physicians. Of the 52 patients, 71% were female and 88% were white; average age was 60 years. Of the 46 academic and community physicians, 83% were male and 78% were white, and they had been in practice for an average of 16 years.

After reviewing transcripts of focus group discussions concerning a hypothetical medical error, the authors discovered that both patients and physicians had unmet needs regarding communication about errors. Patients wanted information about all harmful errors, including what happened, why it happened, how to improve the outcome, and how to prevent recurrences. Physicians agreed that harmful errors should be disclosed but were guarded in what they told patients about errors.

Although patients wanted an apology and other emotional support from physicians following errors, physicians were concerned that an apology might create legal liability. Physicians were also distraught over errors but did not know where to seek emotional support.

"The current response to medical errors may meet neither patients' desire for information about errors nor the needs of patients and physicians for emotional support following an error," the authors write. "Physicians should strive to meet patients' desire for an apology and for information on the nature, cause, and prevention of errors. Institutions should also address the emotional needs of practitioners who are involved in medical errors."

JAMA. 2003;289:1001-1007

Reviewed by Gary D. Vogin, MD