Who’s sorry?

Black and white picture of Connor Sparrowhawk, a young white man with shoulder-length dark hair, wearing a straw hat, eating an ice creamNHS staff told to say ‘I am sorry’ to patients for medical blunders | Society | The Guardian

Recently the health blogosphere and Twitter has been buzzing with talk of NHS managers’ and other public health and social care bureaucrats’ love of the “non-apology” — the statement that they are sorry if we are offended by their statement, or sorry that you are not satisfied, rather than sorry causing injury or death with mistakes or negligence. This report states that “doctors, nurses and midwives” will be subject to “tough new rules designed to make the NHS more honest”, which will compel them to apologise personally for such mistakes:

The General Medical Council (GMC), which regulates doctors, and the Nursing and Midwifery Council think that genuine, personal apologies will help patients overcome their anxiety and distress.

“Patients are likely to find it more meaningful if you offer a personalised apology – for example ‘I am sorry …’ – rather than a general expression of regret about the incident on the organisation’s behalf,” says the guidance, which was prompted by the Mid Staffordshire care scandal.

“Saying ‘I am sorry’ is intuitive. You want to avoid saying, for example, ‘my trust regrets’ or ‘the organisation that I work for regrets’. These could be seen by patients as slightly weasel words. They want a personal apology and for the doctor or the team to show genuine contrition,” said Professor Terence Stephenson, an eminent paediatrician who is the GMC’s chairman.

The report goes on to suggest that the new rules could “ultimately reduce the rising tide of medical negligence against the NHS, which now costs it about £1.3bn a year in damages and legal fees”, because patients often take legal action “because they feel they have not been told the truth about a lapse in safety”:

The guidance will make it much harder for any doctor, nurse or midwife to do what some have done until now, namely keep silent about a failing they have caused or witnessed for fear that that they or their colleagues or employer will be sued. Failure to comply with the regulators’ new instructions will mean that any doctor, nurse or midwife whose conduct prompts a complaint will be judged more harshly when their fitness to practise is being considered by their disciplinary body …

The guidance has been beefed-up since a draft was released last year. It now includes a duty on NHS medical personnel not to obstruct colleagues or ex-colleagues who want to raise concerns about patient safety.

That staff will be expected to be more open and forthright about mistakes they may have made is a good thing, but certainly in the Guardian’s version of events, there is no mention of managers, or staff outside the nursing and medical professions such as healthcare assistants, occupational therapists and care workers in NHS-run units such as assessment and treatment units (ATUs). Some medical mistakes are the fault of those who make them, alone; others are the result of overwork or poor training. As with mistakes in any other field, sometimes a group of people is to blame, but an attempt is made to make a scapegoat of one individual for everything, and this guidance might make it easy for them to blame them not only for a group mistake, but add “lack of candour” to it so as to make sure they are more severely punished, preferably removing them from the group.

The other problem with requiring medical staff to ‘say sorry’ is that it does not state what they should say sorry for. It is possible to say that you are sorry for your patient’s death, for example, without saying you are sorry for causing it, and in cases of severe injury or death, any apology will be couched in such terms as not to constitute an admission of guilt for fear of influencing any legal action. Even van drivers are told by their bosses not to make statements that could be received that way (and presented as evidence against them) in the event of an accident; most ordinary car drivers know this as well. In a case where someone suffers a fatal injury in a unit and is promptly removed to hospital, the family might not get to speak to any of the staff involved, and they may well be ordered not to discuss the incident. So there is still the potential for non-apologies and stonewalling in very serious cases.

And while an apology might be enough for a minor mistake that causes passing distress, it won’t be enough when someone has died, or suffered lasting and life-changing injuries. In such cases, there must be a thorough, independent investigation and the people responsible have to be removed, re-trained or prosecuted as appropriate, as well as the particular failings that led to that being fixed. Sometimes there will need to be financial compensation. Unless the cause really is a mistake (or malicious action) by one individual, the victim or their family will want a fulsome apology and an understanding by the organisation’s leadership that attitudes or behaviours were wrong and a commitment to changing them. Apologies, scapegoating and token resignations aren’t enough.

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