Doctors feel unable to apologise to patients

A “cultural shift” is needed to properly prepare doctors for the introduction of mandatory open disclosure, the organisation providing indemnity cover for the profession has warned.

The Medical Protection Society (MPS) says the Government needs to address these culture barriers to openness in healthcare "before or alongside" new open disclosure legislation is introduced.

Mandating open disclosure, as proposed in the Patient Safety Bill currently before the Oireachtas, will not tackle the real barriers to behavioural change, such as a lack of support from leaders or awareness of existing protections for doctors, it says.

A survey of almost 500 doctors by MPS reveals significant levels of concern and a lack of awareness among doctors about the proposed changes.

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Legally protected

More than 70 per cent of doctors were not aware that the meaning of an apology made where a clinical error occurs has been legally protected in Ireland since 2018. Half of those surveyed thought better support from managers would encourage openness in healthcare, while 47 per cent were fearful of being sued or receiving a complaint.

Nearly 30 per cent of doctors said they were not sure whether or not to apologise to a patient.

One in five doctors said they had been in a situation where they had felt unable to apologise even though there was an expectation from the patient. Of this group, 42 per cent were worried an apology would be an admission of liability.

MPS medical director Dr Rob Hendry said mandatory open disclosure may not result in real behavioural change "and indeed fear of criminal prosecution could even lead to a panicked 'tick-box' process when something goes wrong. This could mean that patients do not get the sincere apology and explanation that doctors want to provide".

“A cultural shift is needed. Clinicians need to be in an environment where they feel empowered and confident to admit errors, apologise and learn from mistakes. This means no fear of blame or personal recrimination, genuine and visible support from leaders equally committed to the principles of open disclosure, and greater education on existing protections for doctors.”