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• Practice points


Apologising when things go wrong can prevent a simple mistake from escalating into a more serious complaint


SORRY T


SAYING


HERE are many opportunities for mistakes to happen in the practice of medicine. Missed or delayed diagnosis, prescribing errors, forgotten referrals, failure to action abnormal results, breaches of confidentiality and communication errors are just a few examples. High-profile scandals involving poor patient care, such


as the failings at Mid Staffordshire Hospital, have reduced public trust in the NHS and doctors. It is hardly surprising that the number of complaints and claims is rising steeply. In January, the health secretary Jeremy Hunt said: “Doctors and nurses must apologise for care failings and should be more open and honest when things go wrong, say sorry to patients and help win back trust in the NHS”. In response to the Francis inquiry into the events at Mid Staffs, the government plans to introduce a new statutory duty of candour this year.


Consider the following scenario: The face at the reception window is angry and weary and pale. “My daughter is in ITU fighting for her life with a ruptured ectopic pregnancy. She saw one of your doctors yesterday who said at her age not to worry because her irregular bleeding was just the menopause. She nearly died.” My heart goes ice cold. I had seen the daughter yesterday, a lovely lady aged 47, but the mother doesn’t know this. What do I do? The mother is not complaining just reporting what happened. Should I speak to her and apologise or will that make it worse? If I say sorry will the family sue me, or should I just wait and see what happens next?


Open and honest In its guidance Good Medical Practice, the General Medical Council is clear about what doctors should do if something goes wrong: You must be open and honest with patients if things go


wrong. If a patient under your care has suffered harm or distress you should:


• Put matters right, if that is possible • Offer an apology • Explain fully and promptly what has happened and the likely short-term and long-term effects. Importantly, the GMC goes on to advise: “Patients who complain about the care or treatment they have received have a right to expect a prompt, open, constructive and honest response including an explanation and, if appropriate, an apology.” Dr Dorothy Armstrong professional adviser to the Scottish Public


Service Ombudsman (SPSO) supports this position. In a recent article for the SPSO, she says that in her experience a complainant’s biggest regret is often that the staff member involved in a mistake or wrongdoing simply was not honest or apologetic. In many cases, she adds, an apology or the truth about what had happened may have prevented a complaint being made or escalated to the Ombudsman.


Fear of liability As GP trainees at the coalface of patient interaction and the delivery of primary care, you are ideally placed to try to defuse a situation that could escalate to a complaint. Be open, be honest, be truthful. Say sorry. But, as shown in our scenario, doctors sometimes worry that an apology may be interpreted as an admission of liability in any potential litigation – a bit like with car insurance. The NHS Litigation Authority, the body which oversees claims made against the health service, has published a four-page guidance booklet for staff called Saying Sorry. It clearly states: “Saying sorry when things go wrong is vital for the


patient, their family and carers, as well as to support learning and improve safety. Of those that have suffered harm as a result of their healthcare 50 per cent wanted an apology and explanation. “Patients their families and carers should receive a meaningful apology – one that is a sincere expression of sorrow or regret for the harm that has occurred.


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