Laws meant to reduce malpractice litigation by protecting doctors who want to apologize to patients don’t work, according to new research.
The analysis provides the most detailed look yet at the impact of apology legislation on such claims.
Reducing malpractice litigation has become a target of policymakers seeking to address the rising cost of health care. Put together, malpractice and defensive medicine—the practice of making treatment decisions to reduce the likelihood of getting sued—costs the United States billions of dollars per year.
“…people sue for money. ‘Sorry’ is not enough.”
One way that policymakers have tried to achieve this is by passing laws that encourage physicians to apologize to patients for treatment mistakes. These laws make apologies inadmissible in court so doctors don’t have to worry that patients will use their apologies against them if they decide to sue anyway.
“The idea is simply that if providers could just say they’re sorry, that’s what patients really want. They really don’t care about punishing the doctor in a financial context, they care about having them express remorse,” says Van Horn. “But what we find is that no, people sue for money. ‘Sorry’ is not enough.”
Surgeons vs. Non-surgeons
Using proprietary data from a major malpractice insurer, the researchers analyzed malpractice claims for about 90 percent of US providers in a single specialty composed of surgeons and non-surgeons—about 9,000 providers. Overall, about 4 percent of these physicians experienced a malpractice claim over the course of eight years. About two-thirds of all claims went to court.
For surgeons, they found, apology laws made no difference in either the number of claims or the share of those claims that ended up in court.
For non-surgeons, however, apology laws had a dramatic effect. While the overall number of claims didn’t change in states with apology laws, those claims were 46 percent more likely to result in a lawsuit. The researchers say that’s probably because surgical errors are usually more obvious than non-surgical ones—for example, a patient will know that a sponge left inside the body is a surgical mistake, but will probably not have the expertise to know whether their worsening illness is due to bad luck or an overlooked symptom. That is, unless the doctor apologizes for it.
In states with apology laws, the payouts to patients of non-surgeons more than doubled compared to those without.
“The laws do protect providers from having their apology introduced in court as evidence that they were at fault, but apologies also alert the injured patients to the physicians’ errors and the possibility of making a successful claim,” Viscusi explains.
Even more dramatic was the change in payouts from successful lawsuits. Again, surgeons didn’t see a great difference, but non-surgeons did. In states with apology laws, the payouts to patients of non-surgeons more than doubled compared to states without apology laws.
How to make ‘I’m sorry’ work
There are clear psychological benefits to apologizing for both physician and patient, Van Horn says, but in order for those benefits to translate into reduced litigation, more work needs to be done.
The researchers note that in some health systems that provide training to their providers on when and how to apologize, lawsuits and payouts are in fact lower. Additionally, the laws themselves could be improved—currently, most only protect physicians for expressions of sympathy, not an explanation of what went wrong. However, recent scholarship on apology best practices suggests that apologies that do include that explanation are more satisfying to victims.
This suggests that while apology laws alone are not enough to reduce malpractice litigation, proper training and more comprehensive laws could potentially be more effective. As they stand now, however, apology laws raise, rather than reduce, malpractice claim risks.
The research appears in the Stanford Law Review. Additional researchers from Vanderbilt and the University of Alabama.
Source: Vanderbilt University
