Imagine your patient had a bad outcome, let’s even say the worst outcome.  Imagine you not only knew why, but who caused it and how it could have been prevented.  Imagine you asked hospital risk management if you could tell the family what happened.  Or asked the hospital leadership or your supervisors.  But their universal answer was a resounding no.

Sadly, this is a common situation at many health systems.  In the U.S. we have a fragmented legal system that does not always support telling the truth to patients.  Saying sorry is an admission of guilt in many states.  Our laws actively disincentivize physicians from telling patients what happened to them.   Oddly, in many states the law protects the physician if they say sorry but won’t protect them if the physician says why they are sorry.  To me it is obvious that apologies should come with explanations. 

Many physicians hold guilt from these kinds of experiences.  As it turns out, there is a better way to handle these situations.  Telling patients and/or their surrogates the truth and apologizing actually reduces litigation.[i]  Patients say they are less likely to sue if given an explanation or apology.[ii]  Partial apologies are more likely to result in litigation than a full apology.[iii]  And physicians experience less distress after adverse outcomes if they felt the disclosure process went well.[iv]

Afterall, don’t we all want to tell the truth?  We need to change the laws in every state to enable physicians and allied health professionals to be honest and forthcoming with patients.  I currently work in a state that mandates such disclosures, even if they don’t protect the apology.  It is a step in the right direction.  Protecting the apology and explanation would be even better. 

In one recent study, 25% of patients suffered an adverse event while hospitalized.[v]  That’s an astounding frequency.  I would bet anything that not all those patients had such events disclosed.  We need to train doctors and nurses on how to disclose adverse events to patients.  Errors are sadly so commonplace that disclosure needs to be part of everyone’s expertise. 

I bet you have never worked at a health system whose mission included intending to harm patients.  Instead, I believe that almost every hospital, nurse, physician and allied health professional strives to provide amazing care.  Despite our best efforts, sometimes patients suffer from errors and omissions.  A holistic view of our patients as human beings means they get to know what happened to them.  Even the nitty gritty and dirty details. 

               In the end, we usually do what we are told.  Physicians are afraid of litigation and trust the hospital lawyers; Afterall, it’s what they do.  Maybe it is time to change the narrative though.  We need to own our wins and our failures through honest discussions with patients and their surrogates.  That’s the world we all really want to live in.    

 Colleen Naglee, MD, JD is a triple boarded physician currently working as a neuroanesthesiologist and neurointensivist.  She graduated from law school in 2023 with the goal to move into patient safety and risk management work.  This article solely reflects her own research and perspectives and is not connected to any current, past, or future employer.

[i] Boothman RC, Imhoff SJ, Campbell DA Jr. Nurturing a culture of patient safety and achieving

lower malpractice risk through disclosure: lessons learned and future directions. Front Health Serv

Manage. 2012 Spring;28(3):13-28.

[ii] Vincent C, Young M, Phillips A. Why do people sue doctors? A study of patients and relatives taking legal action. Lancet. 1994 Jun 25;343(8913):1609-13.

[iii] Ross NE, Newman WJ. The Role of Apology Laws in Medical Malpractice. J Am Acad Psychiatry Law. 2021 Sep;49(3):406-414. 

[iv] Scott SD, Hirschinger LE, Cox KR, McCoig M, Brandt J, Hall LW. The natural history of recovery for the healthcare provider "second victim" after adverse patient events. Qual Saf Health Care. 2009 Oct;18(5):325-30.

[v] Bates DW, Levine DM, Salmasian H, Syrowatka A, Shahian DM, Lipsitz S, Zebrowski JP, Myers LC, Logan MS, Roy CG, Iannaccone C, Frits ML, Volk LA, Dulgarian S, Amato MG, Edrees HH, Sato L, Folcarelli P, Einbinder ca