22 Aug 2014

Why sorry can be the hardest word for doctors

Sorry. It is such a hard word to say. I know because I have a five-year-old and whenever I ask her to apologise for some misdemeanour the most I generally get is a muttered, begrudging apology with body language that says in reality, “No, I’m bloody not sorry but I know if I don’t say it I may get in bigger trouble.”

And so my thoughts turn to the General Medical Council and their proposals that doctors should be make to apologise if they have been found to have done something wrong.  Out to consultation, the idea is that if they have said sorry it will be taken into account when the sanctions are being decided upon.

It is a good idea in principle because over the years I have met numerous patients or their families who would have loved nothing more than to hear the doctor say sorry.  I don’t like the word but it does help with closure.

Yet I am absolutely certain that an apology made because the doctor fears being struck off the medical register would not make the family feel better at all.  It would, indeed, have as much sincerity as my five-year-old thinking she’s not going to get her ice-cream unless she does what she is told.

I am also certain that there are many doctors who would gladly have apologised when a mistake has been made but who will have been told by their management or their lawyers that they should do no such thing.

In fact, I once met a wonderful consultant who had gone out of her way – and against the express wishes of her trust – to apologise to the distraught parents of a baby who had died.  The only problem was she had not actually done anything wrong.  She had tried to save the baby who had been harmed by others.

We know, too,  from what happened at Mid-Staffordshire and from all the evidence from whistleblowers, that the NHS will often go to great lengths to avoid admitting a mistake because they fear the outcome: reputational damage or being sued.

That, in turn, encourages a climate in which the word “sorry” is verboten.  It must be the case, though, that when a trust is prepared to admit errors then they are also prepared to learn from them and that can only be good for the safety of patients.

And if a doctor (or nurse) works in that environment then they are going to feel much easier about owning up when something has happened.

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4 reader comments

  1. Margaret Brandreth-J says:

    You talk about the more serious errors for which trusts should apologise for and then,which really hurts the trust, financially compensate the victims or family.

    Unfortunately things are not so black and white . They may be on documentation which has been edited and put forward as evidence. It may all appear very clear.Litigation is a big business and people are paid a great deal not to admit and say sorry.

    The playground tactics are also apparent where the ring leaders and bullies win ,because they are just that.

  2. henrietta lynch says:

    Very interesting and a sign of the times that we live in – unfortunately this is not only relevant in the case of MDs – somebody should seriously look at what some academic Drs are up to within UK universities today. In some cases, especially within the high profile Russell group universities, academic doctors + those who run universities seem to be largely unaccountable for a lot of their actions which cause harm to students. I speak from personal experience after having been attacked by security guards at a well known London university at the end of studying for my PhD there. The university decided to blame me for the attack at a time when I was extremely vulnerable and had no financial resources to support myself. I gained my PhD but ended up in severe stress + lost my home. I was a mature student at the university and had more than 20 years career experience prior to starting the PhD and certainly did not expect anybody there to behave in the way that they did towards me – I have yet to receive any kind of an apology for the actions of these people, who at no point followed any of their own protocol or systems when originally dealing with this matter. There was no student support and at no point was I allowed to argue my case or had any body who would stand up for me. At all times I sought to resolve the ‘dispute’ through some kind of arbitration, but this was never allowed. I have since sought legal advice but cannot afford to take action, however an apology would be well received and allow me to move on.
    Why is nobody examining the actions of many UK universities as I know I am not alone in having suffered.

  3. anon says:

    Dr Gerada made a good point the other day re this, an apology has to be sincere, now it may be that this word -could- be trotted out say similar to the way the sharks used it before the Treasury select committee ,I’m so sorry…, “I’m so sorry…..if this word was now used cynically by rubbish and uncaring doctors, there are defintely some who should never have been allowed to become docttors and may well have harmed an awful lot of poeple, it could wound further rather than heal?

    also doctors are far too overworked and need less less pressure not more, as they would tell their patients, in some cases where some doctors may even end up killing themselves because of the pressure and blaming, as I think Dr Gerada suggested because of the pressure they are under, and the blaming, this is nothing less than obscene, nothing less.

    the medical profession are NOT responsible for society’s ills and should not be expected to fix them.

    so sorry is a good word but not if misused

    best wishes

  4. H Statton says:

    Personally, I refuse to apologise for apologising, when apologising is the right thing to do. Any decent human being that possesses an ounce of compassion would do the same. For me, if the powers that be don’t like it they can shove it. They are clearly impoverished of sensitivity and integrity. But, the huge majority of people working within healthcare do their very utmost to help those in need, and behave appropriately.

    There are situations where by an accident or death is caused by negligence (everyone makes mistakes), and when it comes to healthcare, it can have very serious legal ramifications. In these circumstances saying sorry is not enough, and at times utterly purposeless. Sadly, ‘sorry’ won’t resolve these situations. This is when a member of staff feels helpless, hopeless even emotionally vulnerable, however much they have been taught to exercise an element of detachment.

    In some situations it is not a case of lying but of simply not telling the whole truth. When no-one is at fault and the worst has happened and someone has died, the family can be spared terrible pain by not knowing every single detail of their relatives passing, particularly if there was a great deal of suffering.

    I have known some junior doctors openly effing and blinding not too far out of a patient’s hearing, range at the end of the ward, simply to impress their firm. “Oh, it’s not that f****** woman again…she’s a f****** pain in the a***”. That attitude is reprehensible, and they fully deserve a dressing down. This behaviour is inexcusable, particularly more so when such foul, dismissive language comes from someone who’s been in the job 30+ years.

    The medical profession is under enormous strain at the moment as everyone knows and yes we all have ‘a bad day at the office’ and can be a little bit grouchy, but there’s no excuse for verbally mistreating a patient.

    Thankfully the callous, insensitive idiots are a small minority. Generally, people that work in the caring professions care. That’s why they do what they do.

    As for the pen-pushers upstairs in the NHS, well, they’re a completely different matter…

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