Sorry: a little word with a big impact

Jul 7, 2014

I still clearly recall an incident that occurred when I was working in the Emergency Department. It was a busy shift and all the doctors and nurses were flat out. I had been looking after a four-year-old child who had come in following a minor head injury.

I had examined the child and she was being kept under observation. While this was happening, I moved on to see an 80-year-old lady who had presented with shortness of breath. I took a history and conducted an examination and then went to order tests.

One of those tests was a chest x-ray. In my haste, I did not realise that I had left my computer screen open on the page of the paediatric patient I was looking after. This meant I inadvertently ordered a chest x-ray for the child rather than the elderly woman.

I did not realise this at the time and shortly afterwards the hospital x-ray department staff came to pick up the paediatric patient for her x-ray. I was attending to the other patient and had no idea that this was happening.

I had previously told her that in the circumstances the child did not need any imaging, so she questioned why an x-ray was being obtained for her child. When the radiology staff called me in the ED I realised my mistake and asked them to bring the child back as the x-ray had been ordered in error.

As you can imagine, the mother was quite upset and annoyed that her child had almost received an unnecessary x-ray. I knew it was important that I apologised to the mother directly and took the time to listen to her as she expressed her annoyance.

I said that I was sorry for what had happened, that it had been an error on my part and thanked her for raising it with the radiology staff. I was very nervous approaching the mother initially – I don’t think anyone likes admitting they were wrong – but after our chat I could tell she felt she had been listened to. The mother ended up thanking me for taking the time to explain what had happened.

Needless to say, I was very careful not to let a similar thing happen again, but I think it helped that I said sorry quickly and took the time to explain what had happened.

Open disclosure

Open disclosure describes the way doctors communicate with patients when an adverse event or harm has occurred. The aim of this process is to provide assistance and support to patients and to ensure healthcare providers learn from adverse events and make changes.

Depending on the nature of the adverse event, it is an exchange that can occur over more than one occasion and should include an apology or expression of regret and a factual explanation of what happened. Giving the patient a chance to convey their experience is an important component of the dialogue, as is providing information about actions taken to prevent it re-occurring.

The key to open disclosure conversations is to say “I am/we are sorry”, offer an explanation of how or why the event occurred, acknowledge the patient’s dissatisfaction with the outcome and, importantly, express concern for the patient.
Apologising or expressing regret should not be an admission of liability. For guidance, find out if your workplace has an open disclosure policy.

Participating in open disclosure is not only beneficial for the patient. Clinicians can also be profoundly affected by adverse events and providing support to staff members involved in an adverse event is an important aspect of the open disclosure process.

Avant supports open disclosure that is in accordance with the National Open Disclosure Framework.

We recommend members contact us prior to becoming involved in the open disclosure process.

For support and advice, call Avant on 1800 128 268. Avant members can also access personal support and counselling through our confidential Member Support Program. Call 1300 360 364.

Learn more

Read ‘Early, effective communication the key to safer practice’ in the Autumn/Winter issue of Connect.

Refer to Avant’s ‘Open disclosure: when to say sorry’ resource page, which includes a downloadable fact sheet.

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