Psychology insights on apologizing to patients

A clinician will make many mistakes during a career practicing medicine. Some mistakes will result in patient harm, wasted resources, or hurt feelings. The adverse consequences of a mistake will also extend back to the clinician and ultimately increase the risk of burnout if not mitigated.¹ One protective strategy is to reduce the frequency of mistakes to zero, but such utopian ideals are not realistic.² Another strategy is to learn how to apologize effectively after a mistake; however, most advice on how to apologize stems from popular press, legal recommendations, ethics analyzes, religious theology, social norms, or community standards and not from scientific evidence.³

Psychology is the science that explores how people perceive, think about, and act toward other people. This science recognizes that interpersonal offenses can occur between a transgressor (also called wrongdoer, harmdoer, offender) and victim (also called sufferer, casualty, target, offended). Examples can include a hurtful comment, betrayal of trust, or interpersonal unfairness. The damaging effects on relationships can be mitigated by an apology, defined as a statement expressing remorse, acknowledging responsibility, and potentially offering restitution. Despite the power of an apology in conflict management, professionals often do not apologize or do not apologize well.⁴

Traditional training and consensus guidelines encourage clinicians to tackle difficult conversations, including the disclosure of upsetting information.⁵ These fundamentals rarely mention how to apologize effectively.^{6, 7} The purpose of this article is to review three unfamiliar findings from psychological science on how to apologize effectively (Table 1). An effective apology, we propose, is an essential clinical skill that does not necessarily materialize from years of clinical practice but might be informed by scientific insights.⁸ Apologies are hard, yet an awareness of these insights might lead to increased clinician motivation, greater patient satisfaction, and ultimately more healing.^9-11

The purpose of presenting evidence from psychological science is not to dissuade clinicians from apologizing by highlighting basic pitfalls; instead, the purpose is exactly the opposite.³² Moreover, a general failure to apologize often occurs because a transgressor does not recognize the offense or morally disengages from the wrongful action.³³ The patterns in clinicians include denying responsibility, characterizing the incident as justifiable, minimizing the loss, or blaming events as outside control.³⁴ Of course, developing skills toward making more effective apologies is difficult since talented clinicians may have few opportunities to apologize and some regions provide no legal safeguards for clinicians who provide an ineffective apology (Table 2).

More effective apologies have several theoretical advantages relevant in medicine. An effective apology is congruent with modern safety systems when errors are a blend of latent systems factors combined with shared individual lapses. An effective apology agrees with institutional risk management that prioritizes hospital safety, operational compliance, and harm prevention. An effective apology might also reduce medico-legal damages even where such statements are admissible as evidence.³⁵ An effective apology can also be an educational topic for motivated trainees that is taught, learned, improved, and role-modeled. Conversely, the prevailing infrequency of apologies in medicine is a potential common and correctable failure of empathy in patient care.

Donald A. Redelmeier: Conceptualization; data curation; formal analysis; formal analysis; funding acquisition; methodology; project administration; resources; supervision; validation; visualization; original draft; revisions. Jada Roach: Data curation; formal analysis; methodology; resources; validation; visualization; and revisions.

The authors declare no conflicts of interest.