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Mike Bryant
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Should Doctors Say “I’m Sorry” ?

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On occasion, Minnesota and other legislatures look at the "I’m Sorry " issue. What’s interesting is that it is usually to bar the use of the statement in a claim. It’s always sounded to me like a "I don’t really mean it" solution.

It can be so sad to talk to people who have been injured and hear their response when the doctor who said they were sorry, later denies they ever said it. The responses usually seem so sincere; they clearly reflect who’s telling the truth. There are even times when they were told "you should get a lawyer" or "we will make sure this is taken care of" and later the insurance company is playing deny, delay, defend with them.

A recent article in American Medical News had some interesting finds:

- The Veterans Health Administration in 1995 adopted a system wide disclosure policy. In 2002, the Joint Commission began requiring disclosure to patients in sentinel event cases. That same year, the University of Michigan Health System adopted a disclosure, apology and compensation policy, cutting litigation costs by $2 million a year and new claims by more than 40%.

- Medical centers affiliated with the University of Illinois at Chicago, Stanford University, Johns Hopkins University and Harvard University also have adopted "I’m sorry" policies. So have Kaiser Permanente’s medical centers, the Catholic Health care West system, and the Children’s Hospitals and Clinics of Minnesota. COPIC Insurance Co., a medical liability carrier in Colorado, started openly communicating about medical errors in 2000 and reimburses patients for costs of up to $30,000.

- The University of Michigan Health System in 2002 adopted a policy of investigating adverse events, sharing the findings with patients and families, and apologizing and offering compensation when appropriate. The system says it has cut litigation costs in half and seen new claims fall by more than 40%.

Open claims
2002 220
2003 193
2004 155
2005 114
2006 106
2007 83

There is some interesting reading out there:

"Disclosing Medical Errors to Patients: It’s Not What You Say, It’s What They Hear," abstract, Journal of General Internal Medicine, September 2009

"Disclosing Harmful Medical Errors to Patients," abstract, New England Journal of Medicine, June 28, 2007

"Disclosure of Medical Injury to Patients: An Improbable Risk Management Strategy," abstract, Health Affairs, January/February 2007

"Choosing Your Words Carefully: How Physicians Would Disclose Harmful Medical Errors to Patients," abstract, Archives of Internal Medicine, Aug. 14/28, 2006

It seems to me that while there are always concerns when you do something wrong, being fair and forthright makes a difference.