Saying “I’m sorry” is the least you can do when you accidentally hurt someone. But in the medical field, malpractice insurance coverage and the fear of medical liability lawsuits— driven in large part by aggressive personal injury lawyers—have created an aura of secrecy and a defensive medicine mentality in which saying nothing has become accepted as a first line of defense.

It’s mandatory for hospitals to tell patients about medical errors. But it isn’t obvious to what degree disclosure policies are followed, even though implementing an “I’m sorry” policy can have positive results. Since 2001, the University of Michigan Health System has adopted a policy of investigating medical errors with an accompanying apology strategy. This cut their litigation costs in half, and new claims declined by 40%. To date, 38 states have adopted “I’m sorry” laws that allow physicians to apologize to patients without fear of legal repercussions. The remaining 12 states allow the admission of benevolent and sympathetic statements into evidence. Many hospitals and insurers have been against apology-and-disclosure policies, worried that transparency could provide more ammunition for frivolous lawsuits. Generally, physicians who are perceived as “nice” by their patients get sued less. It depends on how patients feel they are being treated and if the physician frankly admits responsibility for an adverse event. An admission can disarm a patient and help lessen their anger. It can help if a patient is assured the mistake will not happen again and if the doctor and medical institution promise to rectify the situation to the best of their ability. With a clean record, a doctor can also apply for additional discounts on medical malpractice insurance.

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The SorryWorks! Coalition, a non-profit organization that looks out for patient safety, supports disclosure and apology, as well as upfront compensation (when necessary) after an adverse medical event. The coalition provides teaching and training tools to help healthcare and insurance organizations implement and develop successful disclosure programs. This, in turn, can help change the culture of medicine, medical risk management, and the insurance and legal support structures associated with them.