In the 1970 movie "Love Story" a now-classic line was born: "Love means never having to say you're sorry."
Well, celluloid love isn't medicine, and "I'm sorry" has become the new iconic line in legislation being adopted in states across the nation to give providers greater protection for medical errors against lawsuits.
The latest one was last week when Gov. Rick Snyder of Michigan signed an "I'm sorry" bill. At least 36 states have adopted laws that generally bar physicians' expressions of compassion or sympathy about pain, suffering, or the death of a patient to a patient or family as an admission of liability in medical malpractice suits.
Top officials of the American Medical Association and the American Hospital Association told me that they support the legislation but note that it must be worked within an overall framework of tort reform.
Are we so litigious that we have to legislate feelings of compassion, or just being honest? I guess we are. I'm sorry it has come to this. Saying "I'm sorry" has its practical impact, apparently. The University of Michigan Health System adopted a policy of investigating adverse events in 2002, and included the apology strategy. The health system says it cut litigation costs in half and new claims declined by than 40%.
So, in part, saying "I'm sorry" works. "It's amazing you actually have to pass a law to say you are sorry," saysKenneth Elmassian, DO, an anesthesiologist and member of the board of directors of the Michigan State Medical Society. He also is on the board of the American Society of Anesthesiologists.
When my dad died of cancer in a hospital 15 years ago, my mother felt everyone seemed so cold, so sterile. There were expressions of sympathy, but it seemed perfunctory. In any event, she was not planning to race to an attorney's office to file some malpractice suit. Everyone did what he or she could for my dad. Blame was not in the family's lexicon following my dad's death. Sorrow was.
In Michigan, there is a broad coalition of support for the "I'm sorry" measure, including a group of medical malpractice lawyers. The legislation has an enabling quality for patients as well as physicians, Elmassian says. "Compassion expressed at the time of the event provides closure for families. That's the key point," Elmassian says. "Many times, they want answers for what happened."
Cecil B. Wilson, MD, president of the American Medical Association, said in an interview with HealthLeaders Media that the AMA sees the "I'm Sorry" legislation as "potentially viable." But, he says such measures must be incorporated with other aspects of tort reform to crack down on malpractice litigation, such as medical courts, expert certification procedures and "safe harbors for physicians who practice" under scientific guidelines.
"We think all these things need to be tested to see if it helps us with the challenges we have in medical liability that we think has run amok," Wilson said. "Just the apology itself has to be part of a bigger system to be helpful. The reality is that the current system creates so much animosity." Generally, many lawyers discourage physicians from apologizing, and "certainly most insurers discourage them from apologizing for fear it would hurt them in court," Wilson said.
The overall liability reform is necessary, in part, to "decrease this atmosphere of animosity "and "defensive medicine," Wilson said. "Physicians fear being hauled into court."
Nancy Foster, vice-president for quality and patient safety policy for the American Hospital Association, says that the "I am Sorry" legislation is a step forward in dealing with malpractice issues.
"We believe it is critically important that the physician and hospital maintain an open avenue of communication with patient or patient's family when the patient has been injured due to an unfortunate medical error," Foster said in an interview. "And so things that get in the way of that communication like fear of litigation are not helpful. The fact that someone says I'm sorry shouldn't be held against them in a court of law."
So here we are, at the beginning of healthcare reform, ready to dive in, and one of the prized goals is to reduce medical errors to begin with, enhance quality, and hopefully get rid of ridiculous lawsuits that raise the expense bar in an already inflated healthcare cost system.
As for saying "I'm sorry," that may be a step in the right direction, for medicine. Eventually, maybe healthcare won't need the line anymore.
Even Ryan O'Neal joked about the famous Love Story line in the 1972 movie, "What's Up Doc?" After hearing Barbra Streisand say, "Love means never having to say you're sorry, O'Neal said: "That's the dumbest thing I ever heard."
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
