It's a basic lesson children learn even before their ABCs: Say you're sorry when you hurt someone. But it's now being taught in the grown-up world of medicine as a surprisingly powerful way to soothe patients.
Some tort reform advocates say an apology can even help doctors avoid malpractice lawsuits, especially when combined with an upfront settlement offer.
The idea defies a long tradition in which doctors were taught to be infallible and gained a Godlike image that critics say created an uncomfortable barrier between physicians and patients.
The softer approach, now appearing in some medical school courses and hospital policies, is drawing interest as national attention has turned to reducing both medical errors and the high cost of malpractice insurance, blamed for driving doctors out of business.
Some malpractice reform legislation, including a proposed "Sorry Works" program in Illinois, endorses the idea of apologizing when something goes wrong.
Doctors' often paternalistic relationship with patients is giving way to an understanding that "it's OK to tell the patient the whole story," said Paul Barach, M.D., an anesthesiologist and patient safety researcher at the University of Miami.
It's "a huge sea change as far as our relationships with patients," he said.
One catalyst, Barach said, has been emerging evidence about the scope of medical errors, including the Institute of Medicine's 1999 report that mistakes kill as many as 98,000 hospitalized Americans each year.
Rita Charon, M.D., who teaches medical students at Columbia University about forgiveness, says an apology can help both doctors and patients. Still, she said, there are some errors "that we should not absolve one another for."
Bob Vogt, a retired Cadillac dealership employee from Belleville, Ill., says an apology might not have stopped him from suing over the misdiagnosis of a brain aneurysm in 1990 that he contends left his wife severely disabled. But it might have saved his relationship with the doctor, once a close friend, he said.
"If he had come forward and not tried to conceal the thing, I probably would have had a lot better feeling," Vogt said. "You don't want them to be godlike. They have to be willing to step up to the plate and say, 'I made a mistake.' "
Michael Woods, M.D., a Colorado surgeon and author of Healing Words: The Power of Apology in Medicine, said his own experience a decade ago illustrates the impact of the traditional way doctors have handled mistakes.
Woods was overseeing surgery to remove a patient's appendix. A minimally invasive surgery was planned, but a medical resident accidentally punctured an artery, which led to a more extensive operation. The patient was unhappy with how Woods handled the aftermath, including one visit during which he propped his feet up on the desk and, in her opinion, acted as if he didn't care.
Woods said he wanted to apologize, but legal advisers recommended breaking off contact with the patient when she threatened to sue.
Now a consultant to doctors and the malpractice insurance industry, Woods said his research has shown that being upset with a doctor's behavior often plays a bigger role than the error itself in patients' decisions to sue.
At the University of Michigan Health Systems, encouraging doctors to apologize for mistakes is part of a broader effort to help doctors "feel comfortable in being honest with their patients," said Rick Boothman, a former trial attorney who launched the practice there in 2002.
The system's annual attorneys fees have since dropped from $3 million to $1 million, and malpractice lawsuits and notices of intent to sue have fallen from 262 filed in 2001 to about 130 per year, Boothman said.
Supporters of the concept want the Illinois Legislature to adopt a similar program called "Sorry Works," which recommends offering apologies and financial settlements when mistakes occur.
Under the proposed pilot program, two Illinois hospitals would be recruited to adopt the policy over a two-year trial period to see if it reduces costs.
While the number of settlements would likely increase, lawsuits and sky-high jury awards would decrease, said Doug Wojcieszak, an Edwardsville, Ill., public relations consultant whose victims' rights advocacy group proposed "Sorry Works."
Apologies and upfront settlement offers could mean the difference between settlements costing thousands of dollars and drawn-out malpractice lawsuits costing millions in attorneys fees and jury awards, Wojcieszak said.
When Wojcieszak's brother died after doctors failed to diagnose a heart attack, he said his father wanted to make sure it never happened again but couldn't get doctors to talk to him. "A lawsuit was the only way we could get answers," he said.
"Sorry Works" was part of broader Illinois' malpractice reform efforts that ended in a legislative stalemate last summer, but Wojcieszak is pushing to revive the plan during the Legislature's fall session, starting this week.
He says the idea came from an honesty policy the Veterans Affairs hospital in Lexington, Ky., adopted in 1987 after two big malpractice cases cost the hospital over $1.5 million.
Steve Kraman, M.D., then the hospital's chief of staff, said he helped create the policy as an alternative to the traditional "shut up and fight" risk management model. The center's liability costs subsequently dropped below those of comparable VA hospitals, he said.
"Not only was it the right thing to do, but over the long haul, we were saving money by doing things this way," he said.