Sunday, May 18, 2008

On apologising

Recently I posted on how Americans can "never accept" the Iraqi wish to have an apology for wrongful deaths, instead of mere monetary compensation. In response to a comment from Sunil, I wrote: "... an apology is an implied admission of wrongdoing, which in America will lead to enormous claims of damages. So let's not even think of going there."

So this story in the NYT was quite interesting to read. Apparently some medical centres in that country are experimenting with apologising for errors, and are seeing legal claims against them, and legal costs, come down sharply. From the story:

For decades, malpractice lawyers and insurers have counseled doctors and hospitals to “deny and defend.” Many still warn clients that any admission of fault, or even expression of regret, is likely to invite litigation and imperil careers.

But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach.

By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.

Malpractice lawyers say that what often transforms a reasonable patient into an indignant plaintiff is less an error than its concealment, and the victim’s concern that it will happen again.

Despite some projections that disclosure would prompt a flood of lawsuits, hospitals are reporting decreases in their caseloads and savings in legal costs...

Somehow I'm not surprised, but it is very welcome news. It is also interesting that the lead "apologetic" doctor in that story is of Indian origin. Though I suppose he had his institution's backing to apologise.

In India most doctors of my acquaintance are very approachable, but I have no idea what happens in case of severe error. And if the doctor is not apologetic (and the patient is not convinced that it was a genuine and rare error), there is little legal recourse.

Also one should note that, in the NYT story, the patients who were apologised to did get compensation -- substantially less than what a court may have awarded, but still sizeable. I don't know whether that happens in India at all.


Anant said...

I once saw a most amazing thing on television. There had been a case of tainted blood being given to patients who I guess died as a result in Japan. When the link had been conclusively proved, the executives of the company that was responsible had to go down on bended knees and apologise to the survivors of the victims. If only we had such a possibility in our great land...

km said...

Rahul: Doctors are approachable (for the most part), but just like technology people, rarely ever admit to screwing up :) Maybe it's just human nature. I've never met a plumber who has apologized for not properly fixing a leaky faucet either.

gaddeswarup said...

It seems to go against the findings of an old empirical study as far as the financial gains go. From "Why be honest if honesty doesn't pay"By: Bhide, Amar, Stevenson, Howard H., Harvard Business Review, 00178012, Sep/Oct90, Vol. 68, Issue 5

"Business men and women keep their word because they want to, not because honesty pays.

We bet on the rational case for trust. Economists, ethicists, and business sages had persuaded us that honesty is the best policy, but their evidence seemed weak. Through extensive interviews we hoped to find data that would support their theories and thus, perhaps, encourage higher standards of business behavior.

To our surprise, our pet theories failed to stand up. Treachery, we found, can pay. There is no compelling economic reason to tell the truth or keep one's word--punishment for the treacherous in the real world is neither swift nor sure.

Honesty is, in fact, primarily a moral choice. Businesspeople do tell themselves that in the long run, they will do well by doing good. But there is little factual or logical basis for this conviction. Without values, without a basic preference right over wrong, trust based on such self-delusion would crumble in the face of temptation.

Most of us choose virtue because we want to believe in ourselves and have others respect and believe in us. When push comes to shove, hardheaded businessfolk usually ignore (or fudge) their dollars-and-cents calculations in order to keep their word."

Rahul Siddharthan said...

Interesting comments, all. Especially the Japan thing.

Gaddeswarup -- I'm not sure honesty and displaying contrition are exactly the same thing. Lots of hospitals here in India have extremely dishonest practices, but people go there anyway, especially if the doctors seem "empathetic".

gaddeswarup said...

You are probably right. Dr. Das Gupta's contritution seemed genuine and he seemed to be trying to do the right thing to the patient. You are talking (possiby)of contrition as a strategy which can be financially beneficial.