The first time I encountered this dilemma was while sitting in the back of my “medical law” course in medical school, with a highly esteemed lawyer, who seemed rather stern in his approach, at the front of the class. “Never say sorry.” That was his advice, as saying “I’m sorry” inherently implies you did wrong, which is bad for your institution and your career. I nodded, jotted it down in my notes, then went on a two year study binge where this question never came up again.
Now fast forward three years later, I’m an intern. I’m taking care of a wonderful 70-year-old woman, her sister at her bedside. She was admitted for a bacterial pneumonia and was on broad spectrum antibiotics. The patient in the next bed was a 54-year-old male who was admitted for chest pain, borderline troponins, and was having a diagnostic cardiac cath the next day. As any intern would do, I put in NPO orders for that patient, held his metformin, placed him on strict bed rest and ordered telemetry monitoring on him.
The next day I return to the hospital to check on the cardiac patient, who was eating a full breakfast complete with blueberry pancakes. Looking at my orders, I had placed the orders on the wrong patient with pneumonia, making her NPO and taking away her diabetes medications. Meanwhile, the semi-critical patient was now at risk of not getting his cardiac cath.
“Silly mistake, difficult EMR, bad nurses,” I tell myself. However inherently I knew, this was my fault. I immediately fixed the orders and alerted the cardiologist, who kindly rescheduled the patient. However the patient next door had been thirsty for over 12 hours, without anyone recognizing the mistake. “Why am I not being fed, why can’t I drink? I thought I was supposed to be getting better!” Looking at her, the only two words that came to mind were “I’m sorry.”
I sat down at the edge of her bed and explained to her what happened and that I took the proper steps to correct the mistake. I held her hand, asked her what she wanted for breakfast and personally ordered it for her. I brought her 2 bottles of Fiji water (her favorite) and put them at her bedside. Lastly, based on her family recommendations I purchased a sudoku book to help repair our relationship.
Mistakes happen, they will happen to even the best and most thorough. Saying I’m sorry to patients is liberating, it does not imply error, rather it implies you are human. While saying the words “I’m sorry” is one part of the story, your actions are another. Sit at the patient’s bedside, hold his or her hand. Look at them, tell them that you are sorry this happened to him or her. Although I wouldn’t encourage you saying that you personally made a mistake (as you are not the only clinician or provider taking care of this patient), you are part of the team that could have prevented this from happening. It is your duty to apologize to the patient and to show them you are there for the consequence and will work twice as hard to reverse this process and prevent this from happening to any other patient.
I strongly recommend you go and speak with your patient if you or your team make a mistake, no matter how small. Explain to them why it happened, and genuinely apologize. There will be patients who will be upset and it is your duty to humbly and gracefully listen to them. Offer them your enthusiastic support in overcoming the mistake and mend ways with the patient and his or her family. This interaction may actually improve your relationship with the patient.