For complicated reasons largely having to do with the fact that humans are, by nature, impossibly complicated creatures, "I'm sorry" tends to be among the most difficult-to-utter phrases in the English language.
But for medical doctors, saying, "I'm sorry" isn't just difficult. It's also risky. A doctor who apologizes to a patient runs the risk of his good grace being turned into an admission of malpractice and used against him in court.
The Legislature has passed a bill declaring that a doctor's apology, expression of sympathy or statement of benevolence may not be used as evidence in a malpractice lawsuit. It's a small step toward injecting more humanity into health care and more sanity into courtrooms.
House Bill 24 passed the House 93-3, cleared the Senate 49-0 and, on Tuesday, was sent to the governor. The measure is part of a nationwide trend to reclaim the humanity of medicine from the clutches of an often inhumane legal system.
One of the problems with American-style medicine is that it maintains a façade of infallibility. People tend to place doctors on a pedestal; if anything goes wrong, however, incompetence or carelessness or callousness is assumed. Errors, misjudgments, nice tries and bad luck all too often get elevated to malpractice. Doctors practice in the face of great legal jeopardy, so they buy insurance and they often practice defensive medicine - treating patients with an eye toward building a legal defense, should something not turn out right.
Doctors are human. They make mistakes. They could better learn from them, and so could everyone, but the legal system discourages them from owning up to them. Indeed, the courts have proved that anything they say can and will be used against them in a court of law.
Defensiveness too easily is confused with insensitivity, coldness and arrogance - qualities that juries don't admire any more than patients do.
This is crazy. It's also expensive. The median jury award in a medical malpractice case now exceeds $1 million. It's usually cheaper to settle out of court, but settlements have skyrocketed too - now averaging close to half a million dollars per case. Nationwide, malpractice awards and settlements run an estimated $32 billion a year. But that's just part of the cost. Writing in the Washington Post recently, the president of Johns Hopkins University pegged the added costs of defensive medicine - measures the health care industry employs to guard against lawsuits - at $50 billion to $100 million a year.
We're all sharing in that cost through higher medical costs, higher insurance premiums and higher taxes. All this is money we could be spending on things that actually improve people's health.
The bill awaiting Gov. Brian Schweitzer's signature isn't going to cure all these ills, but it's a start.
As University of Massachusetts School of Medicine chancellor Aaron Lazare, author of "On Apology," declares, "A genuine apology offered and accepted is one of the most profound interactions of civilized people. It has the power to restore damaged relationships heal humiliation and generate forgiveness." In a speech to Missoula physicians last fall, Lazare said early research shows that doctors can reduce lawsuits, cut the cost of malpractice insurance and cut down on medical errors by owning up to mistakes and apologizing for them.
Montana is set to join a handful of other states in making apologies and other expressions of sorrow, condolence and commiseration an acceptable part of bedside manner. Call it a victory of humanity over inanity.
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