Intended for healthcare professionals

Feature Adverse events

You can say sorry

BMJ 2009; 339 doi: (Published 29 July 2009) Cite this as: BMJ 2009;339:b3057
  1. Jane Feinmann, freelance journalist
  1. 1London
  1. jane{at}

    Jane Feinmann assesses initiatives that challenge the idea that doctors cannot afford to apologise when something goes wrong

    “To err is human; to cover up is unforgivable.” So said England’s chief medical officer, Liam Donaldson, at the World Health Organization’s world alliance for patient safety in 2004. In doing so he put an authoritative stamp on growing recognition that when mistakes are made, open disclosure and apologising to patients are essential for safe, effective medicine. Open disclosure is full and frank communication with a patient and his or her family after an incident that may have resulted in harm to that patient.

    Despite widespread support for open disclosure, along with growing public appetite for “revelation, discussion, and resolution,”1 some are concerned that doctors’ behaviour changes little in the aftermath of an adverse incident. In the United Kingdom, the National Patient Safety Agency’s “being open” policy was welcomed when it was introduced in 2005.2 The policy requires trusts to provide information, support, and training to encourage doctors to give patients a full explanation and apology when health care goes wrong.

    But a 2007 review by York University reported that the policy had made slow progress.3 In October 2008 an assessment of the policy’s impact delivered to the National Patient Safety Forum, a group of senior representatives from key organisations, appointed in 2006 as the “national conscience” of the agency, concluded that the policy had had little effect: of fewer than one in three doctors who responded to a survey in 2008, only 64% “held favourable attitudes towards the policy.”4 Open disclosure, however, is an achievable goal. The National Patient Safety Agency is preparing the relaunch of its policy, and a range of initiatives worldwide challenge the belief that doctors cannot afford to say sorry.

    Litigation and disclosure

    The link between …

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