Lately, quite a stir has been made about the utility of saying “I’m sorry” when there has been a medical error or a bad outcome. New information confirms that the act of apologizing has actually been shown to reduce litigation. This makes sense. People sue because they are angry. An apology often disarms an angry person. I’ve seen it work.

Not long after finishing residency, I took a job as medical director at a very nice hospital in rural Ohio. I received a call from a woman who was understandably upset about the care she received. She was quite reasonable and wanted to meet to discuss what had transpired. I agreed to meet and reviewed the chart and talked to the physician involved ahead of the lawyerless meeting.

I learned that a lumbar puncture had been done because of headache. There were 15 WBCs in the CSF. The young physician involved mistakenly thought that this was normal. The patient presented to another hospital the following day and the LP was repeated (I’m not sure why). She had many more white cells in the second sample and was admitted for what turned out to be viral meningitis.

The patient was unhappy about the delay in diagnosis and the need for a second painful procedure. Rather than blame the other hospital for doing a second procedure unnecessarily, or suggest that her illness was “benign,” I simply apologized for the error. It was an error in judgment whether I called it that or not. I explained that the physician involved felt badly about it and had learned from the encounter. She left the meeting satisfied. We wrote off the bill. No lawsuit was filed.

One could claim that in the end there was no significant loss and no basis for a lawsuit. Of course, this person would have said this when Eisenhower was president. Even 20 years ago, the plaintiff’s lawyers were tripping over themselves to get cases. If the patient wanted to file, she would have found someone to do it. This simple apology likely prevented an expensive and painful trip through our civil “justice” system.

I’m convinced that apologizing is good. The corollary of this is that covering things up is bad. People get mad when they learn of a cover-up. And you know what they do when they are angry.

So, what’s the fuss about? This is all pretty straightforward.

In a perfect world there would be no lawyers (no doctors, either). Unfortunately, we all have our roles to play. The defense attorneys tell you to never talk about errors with anyone outside of a peer review setting. If you do talk to anyone about an error, the plaintiff’s attorneys want to use this against you in court.

One of the first lessons in life for most people is to say you’re sorry when you’ve done something wrong: “Jimmy, say you’re sorry for tying your sister’s pony tails in a knot.” Once we become doctors, however, we are “untaught” this important lesson.

Now, we have people trying to teach us this lesson again—except they don’t bake cookies like our moms did. State legislatures in many states have gone so far as to enact laws that say it’s okay to apologize, and this apology can’t be used against you in court.

I understand the benefit of such laws, and I’m happy this protection is in place. Just think for a minute, however, how ludicrous this whole arrangement is. Our society has become so coarse and punitive that we need to have laws to protect us when we do something that was taught to us before we entered kindergarten.

Does anyone else feel like they are in a Twilight Zone episode? When a system of justice becomes so perverse that laws such as this are needed, it’s time to reconsider the manner in which we lay blame and compensate the injured.

Our tort system is choking the life out of medicine and those who practice it. I’m convinced that Congress won’t fix the Medicare payment scheme so that our lobbyists will get tied up working for a temporary fix each year. This way, we won’t have the time or resources to concentrate on other pressing issues.

Hoping that universal health care will save us from this litigation mess? That’s a nice fantasy, but I doubt the plaintiff’s bar would give up the golden goose in trade for world peace.

I believe that this battle will need to be fought state by state. Forget about tort reform. The entire way we, as a society, examine malpractice claims needs to be reinvented. We need to be strong advocates for ourselves and our patients. The current system serves nobody well but the lawyers.

We should work for a health care mediation system that promptly reviews complaints with the help of unbiased experts, and appropriately compensates the injured. Our patients will be better served by a system that seeks the truth through a fair and nonconfrontational approach, rather than through the current courtroom antics and theatrics. A loser-pays arrangement would also curtail much of the nonsense.

There is no quick solution to this issue. Be of good cheer and keep doing the difficult work you do for your patients. Continue to press your elected representatives and the leaders of ACEP, AAEM, and the AMA for meaningful reform.

Your mom was right. If you’ve made a mistake, say you are sorry. Ask for forgiveness. And remember that the grace given to you is received best when you forgive yourself as well. n

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo Medical Center. Your feedback is welcomed at David.Baehren@utoledo.edu.