Country Doc Rule Number Three- Apologies are Necessary

        Years ago there was a movie (was it ‘Love Story’?) where there was a line that said, “Love means never having to say you’re sorry.”

        I’m not so sure that is true in love.  If I forget to take out the garbage I tell my wife I’m sorry.  I can be a dumb man testosterone poisoned lug at times, but with all she does for me I figure it is the least I can do.

        I am certain a ‘no apology’ policy is not good practice as a Doc.  When things go wrong, at least we can say we are sorry.  And I think we owe to to folks to try to figure out why and how it wrong if we can.  I will tell you that is not always easy and often requires some study, but I at least promise folks I’ll work on it.

          Some people say Docs shouldn’t apologize, and that it might make them more at risk for litigation.  Well if that’s true, so be it.  The truth is the truth, even if hard to find at times, and and we should always search for it.

         And if you want to get practical about it, most of the big shots believe it lowers the risk anyway.  It’s a good thing, ’cause I can’t be any other way.

        Like all Docs I’ve had to do a few depositions along the way.  Each time the truth proved to be a powerful ally.  It never let me down, and things worked out fine each time.

        So, at least as far as this Doc goes love means it is best to say you’re sorry if things go wrong.  I don’t give  d@^# as to the assignment of individual blame.  That makes no difference to me.  The main thing is to try to figure out how to tweak the  system and lower the odds a bad event might happen again.  I don’t view apology as a sign of weakness,  although I know some folks do. 

        Julius and I are going to make this our lesson plan for a few days.  While he has been here things have gone well.  But I am in a lower profile job now that I am older.  When I was working day and night it is a wonder more didn’t go wrong than what did.  He is considering a career as a hospitalist, so he might as well start to ponder the issue now rather than later.

         What do you guys think?  I hope you’ll let me know.  As my agent said in the beginning, “Son you are going to learn a lot from your readers.”

Dr. B

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28 Comments on “Country Doc Rule Number Three- Apologies are Necessary”

  1. Karen Says:

    Dr. B., I couldn’t agree more. Saying sorry isn’t a weakness in my book; it’s a strength. It encapsulates a level of integrity, character and internal fortitude that all of us should aspire to. I’ll never a mistake I made when I was teaching. I was new at the school and we had been to a sports carnival. I didn’t know the kids and all the grades were mixed up on the buses. I called the roll and found all my kids were on board and I did a head count. I must have made a mistake somewhere because some little cherub how hadn’t been on my bus on the way there hitched a ride back with me. I discovered this about half way back to school. It wasn’t a problem for me because I knew she was safe. It was a big problem for the teachers still at the sports’ ground who were short a child. This was in the days before mobile phones were common and there was no way for me to let them know. They waited until every last child was on the bus and had to leave with the hope that the child was safe and sound with another teacher. It was a stressful experience for them though.

    The first thing I did when I got back to the school was go and apologise to the principal and explain what happened. In my experience, people are very gracious when they realise a.) you aren’t going to shirk responsibility for what happened and b.) it was a genuine, honest mistake with no ill-will involved.

    If Julius can nail this one he’ll make a great doc. :)

    • drtombibey Says:

      Ms. Karen,

      Your story brings back a memory. One time a child in town was missing briefly and it was very scary. (We found them in a few hours)

      There was a light moment, though. I asked a relative if they thought he could have been kidnapped.

      They replied, “Johnny? No one would steal Johnny!”

      On my.

      Well going back to medicine here are all prayers for a perfect result for Possum. I’m sure he’ll be fine, ’cause we’re gonna do all our worrying ahead of time.

      Dr. B

  2. Mrs. Chili Says:

    I think that the most important part of any apology is the recognition of how another might feel. I don’t care about blame, either, but it matters to me that someone might recognize that I was hurt or upset by something that person did or said. For me, it’s ALL about the empathy; one can’t apologize if one doesn’t recognize another’s feelings…

    • drtombibey Says:

      mrschili,

      That is a nail on the head statement. I have studied some under a man named Dr. Jerry Hickson from Vanderbilt. He is a nationally recognized authority on these issues.

      I believe Dr. Hickson would say that empathy is absolutely imperative in this process. A Doc always needs to think what it would like to be on the other end of the stethoscope.

      Dr. B

  3. Keith White Says:

    Research shows that the LACK of an explanation and an apology lay you more open to litigation.

    • drtombibey Says:

      Keith,

      Thanks for your visit and comment. I agree. That was my country Doc gestalt for many years and I also believe the studies have now verified the old gut feeling has scientific validity.

      Dr. B

  4. Keith White Says:

    In British Columbia there’s a new law coming up which allows you to apologise without admitting liability.

    KW. (Former country Doc).

    • drtombibey Says:

      Dr. White,

      Once a country Doc always a brother my friend.

      I am not sure of the legal status on this in the U.S. Maybe a lawyer will weigh in. I just don’t know on that.

      Dr. B

  5. Kim Justesen Says:

    Hey Doc -

    As Keith said, apologizing makes you less liable to litigation. It was either Dateline or 20/20 (can’t remember which right now)that had a show a few years back on this very topic. The families who were suing the doctors all said that they would have dropped their law suits if their physicians had bothered to say that they were sorry for what happened. They didn’t even necessarily have to admit guilt.

    My hubby and I were bumping heads once (well, it’s happened more than once to be sure), and I was crying to my mom that I knew I was right about the issue, and I wasn’t going to apologize when I was right. My very wise mother said, “Is it more important to be right, or is it more important to begin a new dialog?”

    I immediately apologized, and as soon as I did, my hubby said he was sorry. Then we began arguing over whose fault it had been – each of us taking the blame. Clearly things turned out fine, but I’ve always held to my mom’s words. Is it better to be right, or is an apology the kinder option?

    Kim J.

  6. waggledance Says:

    It’s a strong man (or woman) who can admit a mistake and an even stronger one who can find it within themselves to say ‘sorry’.

    The fear of litigation has a lot to answer for …

  7. junebugger Says:

    Ah, I’m too late. Everyone said what I wanted to say. Saying “I’m sorry” is one of the words I have the hardest time saying. It scrapes at my pride. So when I once fought really bad with my mother, it was the magnitude of my love for her, that built enough courage in me to set down my pride and tell her I was sorry. So to say sorry requires courage, and the courage depends on the depth of ones love, I believe.

  8. drtombibey Says:

    Guys,

    I ran late and had one of those 15 minute country Doc lunches.

    Every one of you have great comments. If Dr. Hickson ever had a T.V. show to address this issue I think he’d want all of you on the panel.

    When y’all talk about families I think that is even tougher. I do know this. When my wife tells me she’d sorry for something it breaks me down and I say, “Awh, heck hon it ain’t your fault…”

    junebugger you are a good kid to be thinking about these things at such a young age.

    Dr. B

  9. junebugger Says:

    Yay! I’m a good kid :) Can’t wait for your next post.

    • drtombibey Says:

      No joke, when I was your age I was dumb as a brick.

      I was very fortunate to be good enough with books to get along and also to have a great wife. It all worked out.

      Dr. B

      • junebugger Says:

        You used your time well!

        Oh, in you comment on my blog, you mentioned “bluegrass music.” I didn’t know what it was until I googled it just now. I’ve seen it before but never knew the name of it.

  10. Julius Says:

    These are some amazing comments, everyone. Even as a student, I feel that apologies are necessary; it may not even be my error that caused the need for an apology, but it must be given. While Dr. B was reading one of the comments to me earlier, I just couldn’t help but to interrupt him with my own comment: Sometimes we forget why we became doctors. As soon as it is realized an apology should be given, any doc should stop and thing again to remind himself, “why did I become a doctor?”

    –Julius

  11. drtombibey Says:

    junebugger,

    Bluegrass is often a misunderstood art form. A lot of folks think it is unsophisticated, but that is far from the case.

    For new young people interested in learning about modern bluegrass here are a smattering of bands or recordings you might listen to. All these folks have web sites and are on MySpace and FaceBook.

    Blue Highway. Lead singer Tim Stafford used to play with Alison Krauss, and wrote much of her early material.

    Alison Krauss. Not just bluegrass these days but she came up in it, and is great in any genre.

    III Tyme Out. Check out ‘Erase the Miles’ a classic saga about the life of a musician on the road missing his girl.

    Tim O’Brien. A versatile Grammy winner multi-instumentalist. Listen to Collen Malone, a sad story about a young man who goes to sea and comes home to visit his girl who now has passed away. The classic line is “As the soft breezes blow through the meadows I go… by the mill with the moss covered stone…Up the pathway I climb through the woods and the vines….To be with my Collene Malone” I am of Scots-Irish descent and these kinds of tunes get to me every time.

    Darin and Brooke Aldridge Quintet. Darin’s opening mandolin solo is a model for perfect tone in an acoustic instrument. Combine it with Brooke’s powerful vocals on ‘Wayfaring Stranger’ and it makes for one of my personal favorites.

    There are many many more. Join me on FaceBook. I post a song of the day, mostly bluegrass, some country, but other genres every so often.

    Dr. B

  12. drtombibey Says:

    Julius,

    This is such a great question. I was at a seminar one time and all these high powered Docs and lawyers were discussing malpractice cases.

    One of those guys stopped everyone is their tracks and got the conversation back to the fundamental question. He said, ‘You should never forget why you became a Doctor.”

    When I started out and they asked me why I wanted to be a Doc I was one of those dumb kids who gave the stereotypical answer. “I like science and I want to help people.” Maybe I wasn’t all dumb though. My answer is still the same and I can’t imagine any other way to have spent my life. It is all I know, except I am also a half a^^ mandolin picker.

    Dr. B


  13. I think that you’re dead on, Doc. Apologizing isn’t admitting weakness, it’s acknowledging responsibility and admitting you’re wrong. Only fools believe they’re never wrong. This is true both in your profession and in love – of course lovers can be wrong, and of course docs can be wrong. My experience is that with good doctors, they never promise you something they’re not sure they can deliver – they can tell you that this is what they hope will happen, but that they can’t promise. Even so, if it doesn’t work, they’ll apologize.

    • drtombibey Says:

      msslightly,

      Ah the wisdom of youth. So true, so true.

      There are no guarantees in medicine, but we have to do our best, be sorry when things don’t go the way we want them to, and try to figure out a way for the next time to have a better outcome.

      I don’t trust any human being who says they are perfect except Jesus.

      Dr. B

  14. gargamel Says:

    Hi Dr. B.,

    I have a slightly different view on this – an apology would not necessarily have priority for me.

    My first priority (and a must) would be the doctor admitting that a mistake has happened. It might even be in exactly that wording: “A mistake has happened”, it doesn’t necessarily have to be “I/We made a mistake” – although I’d prefer the latter, if a personal mistake was the reason.

    Then, I would want to know (rather: demand) a thorough explanation of what went wrong. I want to understand what happened, and why.

    My second priority, and also a must, would be the doctor showing diligence. A mistake has happened, and I would expect the doctor to learn from this, and show that he takes it seriously.

    Generally, I think I could rather stand a doctor’s inaptitude than his inability to admit mistakes, and/or his inability or even unwillingness to learn from a mistake. That’s about the same attitude I have towards professionals in other fields of work, too.

    After this, an apology would be my third priority, and if the first two priorites were satisfactory handled by the doctor, I would not think of it as necessary.

  15. drtombibey Says:

    gargamel,

    At least in the U.S. for for a Doc to say a mistake has happened is almost an apology because we have been cultured not to admit such things.

    And if you apologize but don’t take any action to improve the sitation in a way it isn’t very sincere, huh? The words have to be followed by action.

    Dr. B

  16. Keith White Says:

    Hi, All,

    With respect to “mistakes”, remember that most “mistakes”, (we call them
    “Adverse events”, are systemic failures, and only 40% are deemed to be
    preventable, with changes to the system being necessary.

    The worst inept doctor is the one whose opinion is that he/she never makes mistakes, so why is an apology necessary.

    The worst competent doctor is the one who knows a colleague is inept and/or dangerous and does nothing to intervene.

    Just try to get an incompetent doc off staff.

    The good news is that there are more and more hospitals adopting Quality Assurance procedures based on the Airline Industry, as they learn from the systems errors and make changes in the systems.

    • drtombibey Says:

      Keith,

      Right on. It’s like when a NASA rocket blows up. It is very seldom one small thing but more often a chain of events and the system somehow failed to intervene at several check points.

      I too am scared of the ‘perfect’ doctor.

      The ones who are imcompetent, be it dementia, substance abuse, dishonesty, whatever, should have to go, but it does make for weird politics at times, and is harder than what it sounds.

      I also applaud Quality Assurance to reduce system errors.

      Dr. B


  17. I believe in apologising where I have genuinely been in the wrong. It’s not at all easy – it requires a lot of humility and self-denial – but I have found that it usually works. What bugs me, though, is the way in which some public figures “apologise” for what they’ve done. Some politician or “celebrity” shoots his/her mouth off and causes offence to someone else or to a group of people and, when the solids hit the fan, says something like “I apologise if what I said caused offence” – which is no apology at all. It implies that the person who has been offended is at fault for being offended – a genuine apology would be “I am sorry for causing offence”. A few months ago, I was in a local supermarket, in a bit of a hurry, and I breenged (good Scottish expression) past a mother and young child. I heard the mother say to the child “Sorry for bumping into you – I wouldn’t have if that rude man hadn’t nearly bumped into me!” I realised at once she was talking about me, so I immediately turned round and apologised profusely to both of them. I saw them a few minutes later at the checkout – and they both gave me a really lovely smile!

    • drtombibey Says:

      Martin,

      Yeah, I love the ones where they say, “I’m sorry you feel that way.” It can be worse than no words at all. If the stakes aren’t too high, sometimes all you can do is keep a good humor about it all.

      Dr. B

  18. danny fulks Says:

    It’s a part of one’s education as a professional, or should be. Don’t be defensive. I learned this by trial and error being a stranger in the land of professors among the ivory. I also learned it on the Appalachian Trial. A student upset needs to hear words like, “I could be wrong, have been many times, let’s look at the books, talk about it.” If you can stay cool and show no emotion your nonverbal cues will come through to the student or whomever it may be. I would hate to think I intimidated students or seemed unapproachable, cold. Keep the office door open, take the talk out into a private place in the hall or outside on a bench. Get Cokes from the vending machine, don’t worry about the sugar. Come out from behind your desk, sit. Lean in. Touch the person’s arm. I actually had to learn these behaviors coming from a milieu where rough words and fear were used to control. And the vocabulary was limited. A doctor or a professor, any teacher, has all the power and the strong ones gladly share it with their student friends.

    • drtombibey Says:

      Dr. Fulks,

      I can’t bring myself to call you Dan after such a wise post. If I were a college student I’d take your class and knock myself out for the opportunity to learn.

      When I was in college I was just a dumb kid but I had a couple Profesors like you who changed my life. (I might still be a dumb kid but now I’m an educated one)

      Dr. B


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