Opinion | What Happens When We Apologize to Our Patients?

An ex repeatedly pointed out, perhaps none too kindly, that I was piss-poor at apologizing.

“What do you mean?” I retorted, defensive. “I am not!”

By the second or third accusation, I finally listened. And I am forever grateful for this lesson in apologies. The recipe for “amends,” as they call it in Alcoholics Anonymous, is simple to learn.

I grew up in a family of six, where everyone was bright and strong, and strong-willed. “What did you do in school today?” necessitated an answer with sufficient evidence. As teens, we became proficient in third-degree responses from, “Why exactly should we be quiet so you can sleep in on the weekend?” to “What do you mean it was ‘good’ going door-to-door for McGovern? What did people say, what did you learn?”

Becoming a healthcare provider indoctrinated me further into defending myself. I have never been sued, but I’ve made plenty of mistakes. I started in obstetrics. One patient lost 21-week-old twins due to “cervical insufficiency” that I might have diagnosed if I’d not been in a rush in clinic. It still would have likely been too late to prevent a bad outcome, and she went on to deliver a term baby in a subsequent pregnancy, but that still stings. In psychiatry, I’ve snapped at patients in less-than-my-best moments, or felt I let them down for not anticipating incipient depression or hypo/mania. I’ve wondered what I could have done better when they ended up in a higher level of care, or in the ED.

In “healthcare school,” no one explicitly barks at us, “Never apologize!” But we see colleagues and mentors covering for their mistakes, or for those of other colleagues.

“Yes, we definitely did the best we could with what we knew at the time. Knowing what we know now is hindsight, and probably wouldn’t have made any difference for your…”

“Oh, Dr. So-and-so is an excellent nurse practitioner/physician/PCP/specialist — perhaps they were just having a bad day.”

“I’m sure your IUD falling out/persistent post-op pain/excessive bleeding doesn’t have anything to do with what Dr. So-and-so did…”

Medical “wisdom” covertly, or overtly, says apologizing to a patient (or colleague, for that matter) — any admission of wrongdoing — leaves one open to a lawsuit. Beyond that, it admits imperfection, something we are not allowed or supposed to be in healthcare. Period.

Wrong. Wrong, wrong, wrong, wrong, wrong.

There is incredible power in apologizing. Counter-intuitively, apologizing holds more power than defensiveness. We open and offer our true selves. It takes strength to let our humanity meet another’s in an admission of error. If you don’t believe me, see how anxious you feel the first time you try it (it gets easier over time).

And afterwards, what a relief, to not defend or shield; to have told the full truth.

“I’m so sorry I didn’t think to call and check on you, I know that would have helped.”

“I forgot to send in your prescription, that’s totally my fault.”

“I could have done a better job of following up with my colleague to ensure that didn’t happen to you. I’m so sorry.”

As for the apology recipe, it’s a bit more comprehensive — and satisfying. I’ve put my own spin on it, as you can too. Here it is: “I’m sorry for X, and know it probably felt Y. I’ll try to do better with Z in the future. What did you feel, and what can you tell me that would help?” So, to take the example above as it might apply to psychiatry: “I’m sorry I didn’t call and check in on you when you were feeling so anxious, away from home and our appointments, with your mother in hospice. I know that probably hurt. I’ll really try to remember next time. What was it like for you? What do you want me to know about how it felt?”

You can’t change what’s already happened, but you can actually make it better. As the writer Kevin Hancock says, “Apologies aren’t meant to change the past, they are meant to change the future.”

There is only one caveat. You can’t apologize insincerely; you have to do what you say and actually change your behavior. If you don’t, there goes your credibility. Another (anonymous) favorite apology quote: “An apology without change in behavior…is just manipulation.”

But a true apology? An admission of responsibility, acknowledgment of how we hurt another, and a concrete pledge to repair? Ah, there is a gift. An unexpected and disarming gift to both giver and receiver. In this age of burnout, true professional connection with patients creates gratification and meaning in healthcare. Rather than being an open door to a lawsuit, you’ll find it defuses anger and recrimination. Because it’s deeply felt by both humans.

When I have apologized — to a child, a friend, a patient — the room goes still. The other person pauses. If we are in conflict, everything suddenly softens around the edges. It’s rare and lovely. The other person seems almost stunned, but then grateful. We are two humans, one admitting we make mistakes, the other knowing they do too.

What a relief to admit: even healthcare providers are not immune, not perfect. After an apology, the room seems to sigh, the apology receiver often saying little. Only an honest, calmer, grateful, “Thank you.”

Diane N. Solomon, PhD, PMHNP-BC, runs a private psychiatry practice in Portland, Oregon, and is assistant professor at the Oregon Health & Sciences University School of Nursing. She is also a certified nurse-midwife, immediate past chair of Nurse Practitioners of Oregon, and on the executive committee of the Oregon Wellness Program, offering free mental healthcare to healthcare professionals in Oregon.