An apology can defuse an error
Business Dilemmas
Dr Ellie Mein
Dr Ellie Mein explains how to apologise to a patient following a prescription error
Dilemma 1
Do I say sorry for a scrip mistake?
Q I am a private GP and a patient has written to say they believe I overprescribed their medication which subsequently caused them to be admitted to hospital.
The prescription was started by a consultant the patient had seen privately and the dosage error was made when I prescribed a repeat prescription.
Unfortunately, I had not received a letter from the consultant and I wasn’t able to get a hold of them to confirm the correct dosage, so I had to rely on the patient’s recollection.
Should I apologise for the error or would I be admitting legal liability for something that I feel wasn’t my fault?
A By making a full and frank apology, you will not only reassure the patient but also reduce the likelihood of a complaint or claim in the future.
In addition, as the GMC outlines, you have an ethical duty to apologise if something has gone wrong, explain what happened and what steps will be taken to try to put things right.
Apologies can be provided in writing or in person, but as the patient has written to you, it would generally be appropriate to write back.
Remember that an apology is not an admission of liability in law. Although you may feel that the error wasn’t your fault, it is acceptable to explain your viewpoint while still expressing that you are sorry.
An earnest and sincere apology, made in the first person, such as ‘I am sorry I prescribed a higher dose than you required’, may be all the patient wants to hear.
You can also explain why this happened: ‘As I had not received a letter from your consultant and was not able to contact them, we discussed your current dosage. I am sorry if I misunderstood what you told me.’
All organisations registered with the Care Quality Commission in England must also comply with the statutory duty of candour. While it applies to organisations rather than individual doctors, individuals still have an ethical and professional duty to be honest and open with patients when something goes wrong.
You can always offer a meeting to discuss matters and it can be helpful to advise how you will prevent such issues occurring in the future.
As discussed above, although an apology cannot prevent a complaint or a legal claim from arising, it is more likely to prevent it than a defensive response.
You should rest assured that apologising in this way does not mean you are accepting legal responsibility for what occurred and that a carefully considered genuine apology can prevent further issues down the line.
Dr Ellie Mein is a medico-legal adviser at the Medical Defence Union (MDU)
Problem with social media
Dr Sally Old
The downsides of posting on a private social media group are revealed here in a consultant’s question answered by Dr Sally Old
Dilemma 2
How can I stop this recurring?
Q I’m a consultant cardiologist who recently joined a private Facebook group following a conversation with a colleague who is also a member of the group. On the group, I and several other members discussed a treatment option and shared our experiences of patients who had undergone this treatment.
A few days later, I received a private message from a nurse, who was also a member of the Facebook group and consequently had seen the original post. The nurse explained that when she had seen the post, she knew that one of the patients I referred to was her aunt.
The nurse was extremely angry that her aunt’s health had been discussed online. She has asked for a full, written apology and explanation to be sent to her aunt.
I am mortified and sincerely regret the distress his post had caused. How I can prevent this happening again?
A Social media groups and forums can often be a useful platform to discuss the pressures of being a doctor and many are ‘closed’ forums, meaning that they allow discussion in a discreet ‘members only’ area.
In Doctors’ use of social media (2013), the GMC outlines the principles that doctors must adhere to when posting online.
In it, the GMC states: ‘Although individual pieces of information may not breach confidentiality on their own, the sum of published information online could be enough to identify a patient or someone close to them. You must not use publicly accessible social media to discuss individual patients or their care with those patients or anyone else.’
Consequently, there are a number of factors to consider when accessing closed social media groups and doctors need to be aware of the potential problems and risks when posting their thoughts online.
Firstly, it’s important to remember that these groups and forums can have hundreds of thousands of members. Often, this means that information is accessible to individuals outside the profession. To illustrate, there have been cases when people have used fake credentials to join private groups.
Another important factor to consider is the potential for someone within the group, to take a screenshot of your post and publish it in another forum.
Comments can be taken out of context or misunderstood and it is easy to inadvertently cause offence. As a doctor, you need to consider whether you would be happy for a post to be shared with a wider audience and possibly with no reference to the original context in which it was made.
Social media plays an important role in engaging with the public and with other medical professionals in conservations around healthcare and by establishing national and international professional networks.
However, even when posting in a closed group, consider what the purpose of the post is and who may read it. If you are unsure, it may be best to alter your post or not to post the comment at all.
Dr Sally Old medico-legal adviser at the Medical MDU
- See ‘Asked to be a witness’
