Why should I say sorry? by David Mee-Lee, M.D.
Should we say sorry to clients who have felt wronged by us, as professionals?Even when we believe we weren’t to blame?
As Dr Mee-Lee explains, it can be a very effective way for health professionals to contain difficult situations.
Historically, health professionals have always been advised to avoid saying I'm sorry, assuming it would be argued that the words were an admission of guilt, increasing legal risk. While this seems a reasonable assumption, there is no evidence to support this fear.
In fact, the patients most likely to sue or threaten are those who:
- have been injured or believe they were injured
- did not have comfortable, solid doctor-patient rapport and trust from the outset of the relationship
- are angry about one of the following:
- not having their questions answered
- being given too little information about their condition and treatment
- being treated coldly or dismissively
- other real or imagined slights during the course of treatment¹
Diffuse the situationExpressing apology and saying I'm sorry is much more effective than silence or defensiveness. For a real or perceived mistake or poor outcome, an apology is likely to defuse anger, minimise or eliminate violent outbursts, and prevent legal disputes.
Practise ethical responsibility
Disclosing mistakes and offering apologies are ethical responsibilities supported by various professional, regulatory, and accrediting organisations.
Don’t let shame get in the way
"Many behavioural health professionals have had little experience communicating mistakes because of feelings of shame and guilt."³ During my psychiatric training, I transferred a depressed and suicidal man to the team in a locked psychiatric unit. Days later he suicided by jumping out the window of the hospital. I remember saying to my supervisor that I didn't think I had done anything wrong. Even though I had transferred his care appropriately to a secure psychiatric unit, and was in no way responsible for his death, my first reaction was to somehow feel guilty and wonder what I had done wrong.
Decide what’s best for the long term
Where a client is angry and threatening and feels wronged, but you don't think there was an error, it’s easy to think the client should be the one to realise that their angry accusations or threats of harm are inappropriate and unjustified. My response would be to first rule out any imminent danger (e.g. immediate threats of suicidal or homicidal and violent behaviour) and address this danger (if present) through prompt police action or containment.
If you assess that the client is not about to imminently threaten you with violence, then the safest way to protect yourself is to defuse the anger as quickly as possible – assess, address and apologise for any mistakes made. Do this by either talking to the client on the phone, or preferably in person if possible. The goal is to avoid any actions that would further inflame the client's sense of having been wronged.
Even if the milk of human kindness is not at this moment flowing through your veins, it still makes good sense to reach out to an angry, wronged person (real or perceived) – from a risk management, malpractice prevention, and personal safety point of view. Not to mention it might just be one of the most healing actions you can do for the client (and yourself). Start with an apology for stepping on their toes. I know it’s easier said than done but it is definitely worth the effort. Try it and see.
1 MIEC Special Report Claims Alert (2006) p 2
2 Cesare-Murphy, M (2007). ‘It's important to say if you’re sorry’. Behavioral Healthcare November, pp 38-39
3 Behavioral Healthcare, November (2007) p 38