SUMMARY: Following injury caused by medical error, patients and their families experience mixed emotions. Those who seek further responses from the injuring caregivers are looking for a variety of changes that will help them mitigate the injury. Sincere apology has a number of components. An effective apology fills differing needs in the injured parties.
Patients who have suffered adverse consequences of medical error variously report a range of negative feelings.
Practical PointerEmotional response of victims of medical error:
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Following a medical error, a small minority of seriously injured patients - or their families - will want to take formal action.
In most North American and UK jurisdictions, the victim's legal rights are limited to seeking financial compensation. In contrast, the continental European focus is generally on mediation and finding other alternative methods of addressing complaints about health care. 1 [Full Text]
Where no-fault compensation is available, it is easier to explore the needs of the injured patient or bereaved family. New Zealand is a particularly useful locale for such research, 2 [Full Text] because there are two distinct routes that the victims may take that are readily accessible and user-friendly without the need for legal representation: pecuniary compensation and structured investigation.
Those who seek further responses from the injuring caregivers are looking for a variety of changes that will help them mitigate the injury.
Such injured patients and their families want a variety of responses to the error, that can be categorised as communication, correction, restoration and sanction
Depending on the circumstances and design of the study, the proportion of complainants who report particular motivations can vary widely 2 [Full Text], 3 [Full Text], 4, 5 [Full Text]: correction for prevention of a recurrence 50%-90%, communication 40-80% including explanation 25%-34%. 10%-90% want an apology.
Practical PointerSelf-reported non-pecuniary motivations of medical malpractice litigants:
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Sincere apology has a number of components.
For the physician who has made the medical error merely to acknowledge the injured patient's feelings and express empathy, without acknowledging any responsibility, is usually worse than useless. 6 [Full Text] In many jurisdictions, such expression of sympathy and benevolence is protected by law from being used as evidence in subsequent legal proceedings.
In North America, the number of jurisdictions is increasing in which an authentic apology is inadmissible as litigation evidence.
Practical PointerCharacteristics of true apology: 7 [Full Text]
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Acknowledging the error includes identifying those who made the mistake, providing additional details about what went wrong, and confirming that the erroneous behaviour was unacceptable.
Explanation may tend to mitigate (another medical emergency competing for attention, had been awake and on duty for 36 hours), or aggravate the injury (went for a snack, was not conscientious enough in checking).
Regret includes remorse for not performing up to expected standards and an acknowledgment of intent not to make the same error in the future.
Reparation might include special follow-up services, cancelling fees, or offering a financial settlement.
An effective apology fills differing needs in the injured parties.
Practical PointerUtility of a true apology 6 [Full Text]:
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We have documented elsewhere the suggestion that apologising will reduce the likelihood of litigation. The empirical evidence for such an effect remains mixed.
Copyright © 2008 Electronic Handbook of Legal Medicine