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Apology Programs Are Hot News
There has been a great deal of publicity in the medical community about apology programs ' programs that encourage doctors to affirmatively admit medical mistakes to patients and their families. While there is a lot of support for the idea, there is also a good deal of controversy over whether these programs actually work to reduce litigation and the cost of medical malpractice claims. What, realistically, can apology programs do ' and what can they not do?
How Apology Programs Generally Work
An apology in the medical context has been said to consist of four components: 1) acknowledgment; 2) explanation; 3) expression of remorse; and 4) reparation. Lazare A: Apology in Medical Practice: An Emerging Clinical Skill. JAMA, 2006; 296: 1401-1404. There is a movement afoot to require medical providers to apologize when they make mistakes, especially in light of the knowledge that medical errors occur frequently. Kohn LT, Corrigan JM, Donaldson MS, eds.: To Err Is Human: Building a Safer Health System. Washington, DC, National Academy Press, 2000. Seven states have mandatory notification of adverse events to patients (Nevada, Florida, New Jersey, Pennsylvania, Oregon, Vermont and California). Thirty-four states have varying laws designed to shield expressions of sympathy as proof of liability in court. (Risk Management Consulting accessed at www.sorryworks.net on 7/01/07.) However, no matter the ethical desire to 'do the right thing,' there is little practical information on the litigation consequences of apology. Few institutions have formal systems in place; not only to express the first three components of the medical-setting apology but, more importantly for this article, to adequately compensate patients and their families if a medical mistake has injured them.
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