Medics feel unable to say sorry to patients

The dilemma facing doctors when it comes to being upfront with patients is captured in a new survey which found that one in five has been in a situation where they felt unable to apologise — even when the patient or their family expected an apology.

The barriers to an apology included fear that it would mean an admission of liability, fear of being sued, and uncertainty around whether apologising was the correct thing to do.

More than seven in 10 of the doctors surveyed were unaware that the meaning of an apology has been legally protected in Ireland since the Civil Liability (Amendment) Act 2017 was enacted.

The survey by the Medical Protection Society (MPS), which canvassed the views of 466 doctors, took place against the backdrop of Government plans to make open disclosure mandatory under the Patient Safety Bill 2018.

When that legislation comes into effect, healthcare providers will have a legal duty to disclose serious patient safety incidents. Failure to comply could result in a fine or imprisonment.

The MPS, which has 16,000 members in Ireland, said that while it welcomes the Government’s “desire to build trust and openness between patients and doctors”, — particularly in the wake of the CervicalCheck controversy, where women were not informed that audits of their smear histories had taken place — it felt mandating open disclosure was not the sole solution.

Dr Rob Hendry, MPS medical director, said it would not tackle “the real barriers to behavioural change — such as lack of support from leaders or awareness of existing protections for doctors”.

“MPS has always been of the view that while you can mandate open disclosure through legislation, it may not result in real behavioural change, and indeed fear of criminal prosecution could even lead to a panicked ‘tick-box’ process when something goes wrong.

“This could mean that patients do not get the sincere apology and explanation that doctors want to provide.”

Dr Hendry said a cultural shift was needed, where clinicians felt empowered and confident about admitting to errors, apologising, and learning from mistakes.

“This means no fear of blame or personal recrimination, genuine and visible support from leaders equally committed to the principles of open disclosure, and greater education on existing protections for doctors,” Dr Hendry said.

The MPS survey, which took place between September 9 and October 11 this year, 2019, recorded anonymous comments from doctors giving their view on open disclosure. One doctor said:

“I support disclosure. Not sure if criminal sanctions will change anything other than generate fear.”

Half of the doctors surveyed said better support from management would encourage more openness in the medical profession.