The Impact of Apologies on Patient and Family Trust: A Healthcare Professional's Perspective

How do you feel about doctors and nurses making personal apologies to patients or family members after making major medical errors? Does it matter? Would an admission of an error reduce the likelihood that you would file a lawsuit?

It was one of those 'middle of the night' calls we all dread. To this day, I don’t remember who called me, but it was one of my siblings telling me that my father was in the hospital, overloaded with fluid, suffering from congestive heart failure. I said yes, and everybody who could make it in my immediate family flew up to the hospital.

A Critical Admission Meeting

The head of Pulmonary medicine sat us all down and explained what had happened. The hospital had made an error, overloading Dad with fluid, which caused him to be in the Intensive Care Unit on a ventilator. He told us about various options for care and noted that my father was in the late stages of Alzheimer’s, and we wouldn’t want him to have a tracheostomy.

I appreciated his honesty immensely. It didn’t even cross our conversation to consider a lawsuit. We all had respect for the physician and the hospital for their transparency. The hospital’s transparency didn't come from a lack of reason, as I was not the kind to sue.', 'related keywords', 'medical errors, patient trust, healthcare transparency'

A Wildly Negligent Hospital

My father had previously received perfectly awful care at a different hospital in a different state. This experience would have changed my mind in an instant if there was anything to sue about. Staff members would make up intake/output records, hide his bedside chart, and refuse to wash their hands. The front desk would neglect to answer the call bell, and some staff would only pay attention to him postoperatively if they felt obligated.

The Impact of Hospital Culture and Accountability

There is a significantly different way of treating patients and families after an error in hospitals. I, as a registered nurse and occupational therapist, know that many errors are swept under the rug. Hospitals do not like employees who report errors or abuse. Healthcare is caught in a downward spiral of revenue 'enhancement' that is achieved by short-staffing. Short-staffing is enforced by a culture of silence.

Healthcare professionals know that 'there goes I except for the grace of God.' Anybody and everybody can make errors caused by the frenetic pace of a hospital, which is filled with very sick patients and too few staff. Reporting errors can be suppressed by finger-pointing at the reporter, which can be done overtly or covertly. This reluctance on the part of professional staff to report errors is a huge problem.

A Call for Change

Hospitals need to start paying more attention to the quality of care than to their bottom line. It is my belief that this can't possibly happen until the USA has single-payer health care with an end to profiteering on people's illnesses. In the meantime, 24-hour videography of each patient's care should be part of the standard of care and accessible to each patient as part of their medical record. This will help put an end to the culture of silence.

Although it's universally acknowledged that errors almost always point to system problems rather than human misbehavior, hospitals suppress reporting of errors. This can cause a significant decrease in the quality of care, as staff are less likely to report errors. Ultimately, patients and families will suffer.