1. Viewpoint
Healthcare Radius May 201340
H
ealthcare services are
highly depended on skilled
manpower. With outcomes
depending on multiple var-
iables like man, methods,
machines and materials, errors are unavoid-
able. Literature reports that error is an inevi-
table accompaniment of the human condition,
even among conscientious professionals with
highest standards. But in healthcare, errors
often result in complaints by customers.
Needless to say, in the aftermath of an error
or failure, an apology is needed to provide
much-needed comfort to the patient and his
family. It is, therefore, important for health-
care practitioners to be adequately trained in
open disclosure and apology, to be provided
with adequate support in the aftermath of an
adverse event. Apology, after all, is a tool that
is used by all professionals and practiced in
every profession.
expression of regret, acknowledgment of
expected behaviour and sympathy for the
reproach, repudiation of the behaviour and
the person committing it, promise to behave
correctly in the future, and atonement and
compensation. It should be tendered when
an error has occurred that has resulted in
harm or could result in harm. When errors
and adverse events intersect, there is no way
around an ‘apology’. It should be made within
24 hours of the occurrence of the event. An
early apology that communicates genuine
concern and sympathy for a patient’s physical
and emotional wellbeing is both, valuable and
essential.
Primarily, patients want two things when
the reassurance (to the extent possible) that
steps have been taken to reduce the likelihood
of the event being repeated. Disclosure and
apology can help healthcare professionals
and hospitals heal and preserve relationships
with their patients. The American Medical
Association Code of Ethics states that a physi-
cian is required to disclose to a patient when a
mistake is made.
General Medical Council (2006) pro-
vides helpful guidance for doctors related
to patients, who complain about the care or
treatment they have received. It states that
the patients have a right to expect a prompt,
open, constructive and honest response,
including an explanation and, if appropriate,
an apology. When patients feel they have re-
ceived a sincere statement, saying sorry, they
feel respected and validated, and their trust is
often restored.
According to Dr A Lazare in his article
-
ing clinical skill’ in JAMA 2006, an apology
Recognition of the event that caused harm.
An expression of regret and sympathy (the
partial apology).
An acknowledgement of responsibility—
where appropriate—once the facts are fully
understood (the full apology).
Effective reparation.
One or more opportunities to meet again
John Kador, an accomplished business writer,
1. Recognition.
2. Responsibility.
3. Remorse.
4. Restitution.
5. Repetition.
An apology made by or on behalf of a person
in connection with any matter, does not, in
law, constitute an express or implied admis-
sion of fault or liability by the person in
connection with that matter. Internationally,
a number of studies support the view that
a policy of open disclosure coupled with a
sincere apology may actually reduce the like-
lihood of time-consuming and expensive legal
disputes. Internationally, a number of organi-
sations have instituted training programmes
to help medical students and doctors who are
“illiterate in the language of apology”.
Many adverse events cannot be prevented
distress. Customers often feel betrayed by the
very people they have entrusted for providing
them with care. So, an apology can bring com-
fort to the patient, forgiveness to the health
practitioner, and help restore trust. Literature
points out that customers have more trust in
the healthcare system after an adverse event,
than before it, if the event is handled with
transparency and maturity.
Save it with a
Whether you are an independent doctor or an
organisation, tendering an apology in case of an error
is the best way to salvage relationship with patients
BY DR AK KHANDELWAL
Dr AK Khandelwal
is medical director at
AnandaLoke Hospital &
Neurosciences Centre,
Siliguri, West Bengal.