Sorry Seems to Be the Hardest Word

Should health care providers apologize when a medical error occurs? There is a growing feeling that the answer to this question is “yes”. Both the American Medical Association (AMA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) state full disclosure to the patient should be made when a medical error occurs. (Leape, 2006) However, there is a big difference between full disclosure and an outright apology to the patient.
Two of the main arguments behind advocating apologies are that lawsuits are avoided and healing can begin both for the patient and the provider. (Leape, 2006) According to a report from the American College of Physician Executives (ACPE), feelings are mixed, but many executives feel open communication that includes an apology will avoid many lawsuits. (Weber, 2006) Resentment by patients who feel physicians and healthcare organizations are less than honest is sited as a major reason to advance tort claims. Many patients and family members file suit to find out the truth. (Leape, 2006)
The need to begin healing for both the patient and the provider is reported as a primary reason to give an early apology. One hospital executive in Wisconsin reports that she/he sees physicians come to terms with their mistakes by offering an apology. (Weber, 2006) Leape also states “Apology is not an ethical right, but a therapeutic necessity. Apology makes it possible for the patient to recognize our humanity, our fallibility, our remorse at having caused harm.” She adds, “It makes it possible for the patient to forgive us.” (Leape, 2006) While I see the value of apologies in the healing process, I disagree that apologies are a needed step for forgiveness. Alexander Pope is credited with the famous quote, “To err is human, to forgive divine.” The choice to forgive or not to forgive lies with the patient. An apology does not predetermine forgiveness and forgiveness can be given without an apology. That power lies at all times with the offended party. While a positive step in healing, there are many views to consider before quickly offering an open apology.
Practitioners need to be aware of their relationship to other healthcare provider’s, organizations and insurance companies and understand that their actions can impact with many individuals including their patients. There are many relationships with the issue of trust to be considered when a medical error occurs. Ten states now have laws on their books that protect a physician’s apology from being admitted as evidence in court. (Weber, 2006) The National Medical Error Disclosure and Compensation (MEDiC) Act of 2005 has been introduced to congress which protects a physician’s apology and requires time for parties to negotiate compensation for damages. (Weber, 2006) Even with these positive steps, an apology can be risky. A physician who apologizes for his/her individual actions could be including the entire medical team and system. At other times it may be determined later on that the individual apologizing actually was not at fault, too late to take back words spoken. (Butcher, 2006)
Many lawyers and risk managers still feel an apology, no matter how well intended can be used as an admission of guilt. A professional who utters the words, “I am sorry” needs to know what they are admitting to. Many lawyers agree that offering an apology to a patient becomes very difficult to defend against. (Butcher, 2006) While an apology may head off possible litigation, that same apology could be the evidence that a physician will regret.


Butcher, L., (March/April, 2006), Lawyers Say “Sorry” May Sink You In Court, Physician Executive, 32, 2, 20-25.

Leape, L., L., (March/April, 2006), Full Disclosure and Apology – An Idea Whose Time Has Come, Physician Executive, 32, 2, 16-18.

Weber, D. O., (March/April, 2006), Who’s Sorry Now?, Physician Executive, 32, 2, 6-12.

What to do?

Early in my career, I worked as an athletic trainer for a company I am not currently with. I was contracted out to a school with a dominant football program. We had two excellent running backs and in week eight of the season one of the running backs fractured his wrist. Five weeks later in the state playoff quarterfinal game, the second running back fractured his wrist during the Friday night game. On Saturday morning the running back saw our team physician and was placed in a splint. It was clear his season was over and it was going to be difficult for our team to win the state semi-final game without him. Prior to these injuries we were the favorite to win the state championship.

All season long the head football coach and athletic director for the school had put a lot of pressure on me to keep student-athletes playing, even when it was questionable or clear the student-athlete should not be participating.

On the following Tuesday afternoon, prior to practice, the schools athletic director and head football coach pulled me aside and told me the mother of the player who had been injured four days prior, wanted her son to play. A doctor had not cleared him but the player would play and if I had a problem with it I should leave immediately. No written permission from the mother was presented and only the word of the school officials was given. The fracture site was at the epiphyseal joint causing a significant risk for further damage if the athlete injured his wrist further. What was I to do? If I left, I was walking out on 60 other student athletes. Many of which I was providing treatment or splinting and/or taping for prevention. Also, if someone was injured after I left, there was not a trained professional present to provide care. If I stayed I could put both myself, and my company in a position of increased liability if I treated a player without proper clearance to return to activity. I had to think quickly and make the right decision.

I told the athletic director and the head coach I did not agree with their decision to allow the student-athlete to compete and questioned the information the mother was receiving. I had spoken with the mother on Saturday after her son had seen the physician and she gave no indication she wanted to see her son play. I further stated that I would not leave the team, but I also could not provide any treatment, such as padding, splinting, taping or a soft cast, to the injured athlete in question. I also informed the athletic director and coach I would discuss further action with my supervisor.

I immediately called my supervisor and informed him of the situation. His immediate reaction was to have me follow my plan and he called our company lawyers to seek clarification. The next morning I met with my supervisor and we decided to draft a letter to the school district superintendent expressing our concern for the student-athlete, the schools liability, and our position that we would not provide care to the concerned party unless it was a new acute situation. We hand delivered the letter that day, Wednesday, to the school district office and also faxed the letter to our lawyers.

The superintendent of schools did not know about the situation until we notified him. He immediately took the case to the school’s lawyers and they then informed the school that the athlete could not play unless cleared by a physician.

The reaction of the head coach was to blame me for the athlete’s inability to play that Friday and the team subsequently lost the state semi-final game that Friday.

Our reaction was to protect the injured student-athlete and also the rest of the team by attempting to work through proper channels. If I had walked out of practice when first confronted, this could have ended very ugly. We did a number of steps correctly. We saw the ethical issues involved and thoughtfully reacted. We properly identified the stakeholders including the entire team. We looked at the possible effect on our organization as well as the school district including the student-athletes. We sought wise counsel from our colleagues, including legal advice. Finally we utilized our key resources, primarily our relationships with the superintendent, to seek a successful solution. This was an excellent learning experience in a very heated environment.

Welcome to RobertBuEthics. My name is Robert M. Burton. This site is for University of Central Florida Health Care Ethics class HSC 6656, summer 2006 semester. I welcome and look forward to your comments and feedback.

A little bit about myself. I am clinically trained as a Certified Athletic Trainer and am licensed in the state of Florida. I currently work as the Sports Medicine Coordinator for an HCA owned hospital in St. Lucie County, Florida. My planned graduation date is after the Spring semester of 2007.

Welcome and I hope you enjoy this site.