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Saying Sorry - by Suzanne Delbanco, Ph.D.

If our health care system were highly reliable, the debate whether to say sorry to patients harmed by preventable medical mistakes would occur far less frequently.  However, until we have the processes and systems in place to reduce the incidence of preventable errors drastically, everyone from individual clinicians to patients' families to CEOs of major health care systems will have to discuss what's right to do when mistakes happen.

In an on-line commentary posted yesterday to the BBC Web site, Sir Liam Donaldson, Chief Medical Officer for England, argues that the National Health Service (NHS) needs to apologize more, and to mean it.

NHS clinical staff have a range of attitudes about apologizing, with some favoring being open in the face of errors, and others saying "over my dead body."  Being fully or partly responsible for harming a patient can be just as painful emotionally for the clinician as for the patient or patient's family.  And while saying sorry may be the start of emotional healing for all parties, Donaldson suggests that an apology is not meaningful until it becomes the start of a process to learn from the mistake so that future patients are spared similar harm.

This is remarkable leadership from the head of a closely-watched health care system.  We have much more to learn about this issue and far to go in evolving "apology" policies that work for both health care professionals and patients.  Many have studied the connection between apologies and lawsuits, finding that saying sorry can reduce the likelihood of a patient bringing suit to seek compensation for injuries from medical care.  Liability concerns raise the costs of care through rising malpractice insurance premiums.  Such concerns may also lead to the delivery of defensive medicine, during which clinicians may, for example, order extra but unnecessary tests to avoid accusations of not being thorough.

Reducing the likelihood of medical mistakes through methods like Hospital Video Auditing from Arrowsight, Inc., as well as others, is a critical aspect of moving forward.  But let's figure out how to work in "saying sorry."  It's the right thing to do and the benefits will likely have a beneficial ripple effect for all involved.

Suzanne Delbanco is President, Health Care Division, Arrowsight, Inc.

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