Revelation of Adverse Events and the Conundrum of an Apology

and procedure. Currently, a few institutions have policies for disclosure of error that often include an apology. Approximately 30 states have passed legislation making physician’s apologies, including admission of fault, subsequently inadmissible in malpractice litigation. Not all these statutes are equally protective of physicians. Other states have laws allowing expression of regret, caring, and consolation without admitting fault.

Recently, prompt disclosure of medical error to the patient in a timely manner has been endorsed as ethically proper by the American Medical Association (AMA). Furthermore, honest dialogue is regarded as a means of strengthening the relationship between a physician and a patient, thereby enhancing the prevention of litigation. No action should be taken by a physician or a member of his or her office staff before a thorough investigation of the case, circumstances, results, and possible attendant damages have been discussed with the insurance company and the appropriate lawyers. However, some states require that the patient or the patient’s family be advised of the adverse event during the episode of care or, if discovered afterward, in a timely fashion. Therefore, prompt investigation and evaluation on the physician’s part is recommended.