More than words? Patient insights on the impact of medical apology

Increasingly, jurisdictions are adopting “apology legislation” that allows clinicians to apologize to patients when an adverse event occurs while disallowing the introduction of the apology in a liability case as evidence of fault or liability.

Apology legislation exists in Canada, Australia, the USA and the UK. In Canada, nine provinces and two territories have adopted apology legislation (BC first adopted in 2006). An apology is defined in Canadian legislation as “Encompassing an expression of sympathy and regret and a statement that one is sorry, or any other words or actions indicating contrition or commiseration, whether or not the words or actions admit or imply an admission of fault” (CMPA website). While apology legislation is established in Canada, little is known about the impact of apologies on various stakeholders, or the impact the legislation has on health care more generally. The existing literature on medical apologies is largely focused on the American context and is often limited to the potential impacts rather than the actual impacts as they are experienced by stakeholders. It is unknown whether impacts are differentiated for specific patient groups, such as Indigenous populations whom, research consistently shows, often experience highly differentiated processes and outcomes in health care.

Data was collected in two provinces (BC and MB) from qualitative interviews with patients who experienced a medical error and who did or did not receive an apology. Data was also collected via interviews with patient safety experts, clinicians, health care administrators, and medical school administrators. There is rich data providing original insight into how and whether giving/receiving an apology improves learning, accountability, patient safety, and healing (for both the patient and clinician). With this data, YouTube videos, op-eds and blog posts will be developed to share the findings with patients, clinicians, and administrators. The dissemination products will emphasize these themes: 1) Various traumas associated with medical errors/mistreatment; 2) The components of a meaningful medical apology for clinicians and administrators; 3) Impacts of apology on both patient and clinician; 4) Indigenous perspectives on medical apologies.

The findings will be presented at the 2019 BCPSQC Quality Forum. Participants at this event include physicians, nurses, pharmacists, allied health professionals and students.