Words That Heal

An apology is a complicated thing. Coming clean is hard; if done poorly, it can make things worse. Just ask Bill Clinton or Pete Rose. But when done right, talking can be powerfully productive, as suggested in the article by Mazor and colleagues in this issue (1).

As former litigators and now mediators and clinical law teachers, we have spent our careers learning how conflicts arise and what is really at stake when people sue. We have also learned how words can be used to change perceptions and, ultimately, to find constructive and less costly ways to resolve conflicts. Our experience has taught us how nuanced the subject of apology can be. Apologies have a potential for healing that is matched only by the difficulty most people have in offering them.

Physicians as a group face special challenges in this realm. Like the rest of us, physicians are subject to shame, guilt, and grief when their actions harm others, even if fault is unclear. These feelings, coupled with the fear of litigation that permeates medicine, may get in the way of effective communication with patients and their families after a medical error. In addition, since statements of sympathy, regret, or responsibility can be used to prove legal liability in medical malpractice cases in many states, lawyers and risk managers routinely advise physicians against being open about what happened and against apologizing, especially at the time when such communications might be most valued by a patient.

These personal and institutional impediments to openness are at odds with what research is beginning to show us: that ineffective communication is the single largest factor in producing patient litigation (2) and that good communication, including effective apologies, can avert or help end conflict, especially …