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HEALTHCARE PRACTICE


said: “Particularly in the health service, there is a resistance to saying sorry when things have gone wrong. Tat is a great barrier.” Tere are many reasons for this resistance.


An overriding concern is that by apologising you may be admitting liability. Section 2 of the Compensation Act 2006 (an act of the UK Parliament) says: “an apology, an offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty”. Tis particular section only applies in


England and Wales. My understanding is that the law on this point is likely to be regarded similarly in Scotland. Te proposed Apologies (Scotland) Bill – now under consideration by the Scottish Parliament – covers similar territory and includes protection against admissions of liability.


No such thing as perfect Tere are, of course, cultural barriers to making an apology, particularly in the medical world. Te elitist and macho culture that is at times present in our hospitals and surgeries has always puzzled me. If the reason for being a doctor is to help people (as we all said when trying to get into medical school), why do we maintain the culture of always having to be right? Why do we find it so difficult admitting mistakes? Psychiatrist Aaron Lazare, author of the


book On Apology, wrote: “We tend to view apologies as a sign of a weak character. But in fact they require great strength. “Despite its importance apologising is


antithetical to the ever-persuasive values of winning, success and perfection. Te successful apology requires empathy and the security and strength to admit fault, failure and weakness. But we are so busy winning that we can’t concede our own mistakes.” No doubt this will resonate with many


medical professionals. So can we learn to be more rational about acknowledging mistakes? When it looks like things have gone


wrong, correctly interpreting what has happened is important for both sides. Complainants are oſten unable to differentiate between poor service and negligence, and doctors oſten don’t distinguish between making a mistake and being negligent. We all make mistakes. Tey are an inevitable part of being human, especially when practising a high-risk


AUTUMN 2014


profession like medicine. Doctors do not get sued (successfully) for


making mistakes – they get sued for being negligent. So if you have made a mistake, own up. Be honest and say sorry. It won’t do any harm and it may do a lot of good (apart from being the right thing to do). Doctors do sometimes get sued for practising below an acceptable standard of care – if that substandard care results in harm to a patient for whom we have a duty of care. Remember that if you have been negligent, evidence has shown that a heartfelt apology can reduce the likelihood of legal action – but some form of intervention may be inevitable no matter what you do. To my mind that is fair enough.


Apology – a reasonable response While many doctors have good communication skills and make appropriate apologies, I think there needs to be a cultural change within the UK medical fraternity for apologies to be more widely accepted. One change that may help is teaching our undergraduates the importance of being able to recognise their mistakes and say sorry for them. As well as working as a GP, I am a medical adviser to the SPSO. Te vast majority of


reviewer this, and oſten the complaint will not be upheld. A genuine apology when a mistake has


happened is usually thought to be part of acting reasonably. To have not apologised properly will, at times, weigh the case against the doctor. Making a proper apology is a frequent recommendation from the ombudsman. If this has already been done then the ombudsman may feel there is nothing to be achieved by investigating the complaint further. In my opinion, until we change the


perception of apology from an admission of failure that may ruin our reputation to a sign of professional and emotional strength, we will still see patients pursuing complaints and legal actions that would never have happened had the doctor just said sorry and meant it. When a complaint comes in or a mistake is noticed, I would urge my colleagues to act with integrity and professionalism. Take a deep breath and try to see both


sides of the issue. If the patient has been upset or harmed, acknowledge this and let them know how genuinely sorry you are that they have suffered. If you can see that your actions have contributed to a mistake, acknowledge this and let the patient know


“Doctors often don’t distinguish between making a mistake and being negligent. We all make mistakes. They are an inevitable part of being human”


complaints that are escalated to the SPSO, having failed to be resolved at a local level, would in my opinion never come to us if the doctors involved had sat back and tried to see things from the complainant’s point of view. If we could allow our defences to drop and consider our patient’s position I am convinced the number of complaints being referred to the SPSO would reduce. We understand that having a complaint


sent to the ombudsman is stressful for doctors. Te ombudsman uses the standard of reasonableness – what would we have expected a reasonable doctor to do? Te ombudsman’s medical advisers all work in the NHS and have good insight into the different perceptions doctors and patients have. If an adviser finds that a doctor has acted reasonably they will tell the complaints


you are genuinely sorry. Explain what happened and how you plan to ensure it does not happen again. I am convinced that this empathic and professional approach will be more likely to result in the hurt and anger around a complaint dissipating without further action being taken. NHS Education for Scotland and the


SPSO have developed an online module about apology. I recommend taking the 20 minutes required to work through it. It will leave you well informed about how to make an apology that your patient will appreciate.


n Dr John Dudgeon is a GP and medical adviser with the Scottish Public Services Ombudsman


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