Teaching Doctors How to Say “I’m Sorry”

Seven years ago, on a hill overlooking Portland, I taught fifteen medical students how to apologize. It wasn’t part of their curriculum. It wasn’t why I was invited to speak.

But life is about seizing opportunities. In this case, the opportunity was to transform the grief of losing a child into a teachable moment. Not by lecturing. Not even by telling a story. But by cajoling future doctors to say out loud the words I wished I had heard six months before.

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What followed was a test case for the notion that you are what you say—and that what you say matters—a lot.

Sorry

The invitation came from an OB/GYN known in the community for being compassionate with patients, particularly those with difficult pregnancies. He wasn’t our physician, but he heard about us through the grapevine. And we knew him by reputation.

My initial response was to decline. The loss was still recent—after death, six months can feel like six minutes—and I felt raw. Telling the story in detail wasn’t the problem. I knew it cold. And I was perfectly comfortable with shedding tears—crying, which rarely comes easily to me, had become my best form of relief. Each tear made my body less tense and more able to handle life. What concerned me is that I would go on an angry rampage. Our doctor, a respected neonatal specialist, had made a sloppy error and then lied to cover it up. The error may or may not have caused our daughter’s death, but it had definitely turned a tragic situation into a full-blown trauma. (The detailed story, which I won’t share here, makes this clear). I had just brought the error to the hospital’s quality council and been rebuffed. It was CYA all the way, and it left me more hurt and angry.

The whole experience, which would require a book to tell in detail, left me pissed off at our doctor, resentful toward the hospital, and disappointed with the health care system in general. This mood placed me at risk of exploding in front of the students, or at least speaking with an edge that would make it harder for them to listen to me.

My instinct, therefore, was to say “No thank you.” Instead, it came out as “Let me think about this a bit.” (I’ve learned through the years to temper my tendency to immediately say “no” to requests by buying myself some time).

Taking a few minutes to consider the situation turned out to be a wise choice. There was no denying that I was angry and that part of me sought revenge. Clearly, blowing up in front of the students would be stupid and wasn’t an Amiel thing to do. However, I realized that deciding what I didn’t want wasn’t the same thing as deciding what I did want. So I asked myself, What is it you really want to have happen here?

The answer came quickly. It wasn’t to help these students avoid making errors. After all, most errors are due to poor systems and processes. Nor was my goal to teach them that lying and covering up are wrong. Morality takes years to develop, and I had an hour. Instead, what I wanted was simpler.

I wanted to teach these future doctors how to say, “I’m sorry.”

Our doctor had not said this. Nor had any of the members of the hospital’s quality council. Nobody apologized. In fact, what they did was more egregious than not apologizing. They gave us the runaround.

So here was the opportunity: to teach the medical students to say what my wife and I had not yet heard: “I’m sorry.”

Here’s how it went: For the first forty minutes, I told our story and took their questions. I cried, as did some of the students. As for my anger, I expressed it in the cleanest way I knew how—by saying, “I felt angry at our doctor” and “I’m still angry now.” This felt clean because it was me taking responsibility for my anger, not trying to blame someone else for it.

Once it was clear that I had connected with them, I pivoted to the activity that had drawn me to show up.

“Now, I have a request for you. I can see that all of you have really taken in this story. And I imagine that at least some of you wish you could do something now. Well, you can’t take away my emotions, because they’re what they are, and I’m the one who generates them. But you can humor a grieving father by doing something you probably have never been asked before. Actually, that’s an assumption. Let me get a show of hands. How many of you have ever been taught to say ‘I’m sorry.'”

A few hands shot up. “Who taught you this?” The response was unanimous, “My parents.”

“OK,” I continued. “Let me have another show of hands. How many of you have been taught in your medical education to say, ‘I’m sorry.'”

No hands this time.

“That’s what I thought. No wonder many doctors don’t apologize. Nobody tells them it’s important, much less teaches them how. Well, that’s what I’m going to do. It will help you, and it will also help me. Are you up for this?”

A line of heads nodded up and down.

“OK, here goes.”

Practicing How To Apologize

I proceeded to walk them through a structured process of apologizing. First, I had them repeat after me, slowly and out loud, “I’m sorry.” Not once but five times, and in unison. After each iteration, I asked them to pause, take a few breaths, and notice what they were feeling. “Yeah, I know this is kind of weird. But I really appreciate it. And you’re all still alive, right? Saying that you’re sorry hasn’t killed you, has it? And your brain is still intact, right? OK, let’s keep going.”

Part two was more challenging. I had them say out loud, again at a slow pace, “I made a mistake, and I’m sorry.” The idea here was to not just apologize, but to explicitly claim responsibility by declaring that they had made a mistake.

This was a bit harder for the group. It took longer for everyone to start, and a few people stumbled over the words. (Yeah, I know, how hard is it to repeat a few simple words? Apparently, pretty hard when the words go against everything you’ve been taught). But they did it. So I had them repeat these phrases seven more times. Why seven? No reason—I just felt like it.

When they finished, I again pointed out that everyone was still alive and breathing. “Everyone’s eyes are open. Your brains still seemed to be working. In fact, some of you look more alert than when you walked in the room.” That prompted a few chuckles.

Practice complete.

I closed by expressing my gratitude to the class for being willing to do this unusual exercise with me. And I made one final request: “My hope is that this is just a start. If you want to get good at anything, you have to practice it a lot. Today, we practiced apologizing thirteen times. That’s a good start. But if you want to be able to do this with patients in real life, especially when you’re feeling stressed because you have just made a mistake, you have to practice this a lot more. Like a few hundred more times before you graduate.”

And then I left.

Five Lessons

I didn’t ask anyone to commit to practicing after walking out of the room. But my points were clear to them, as I imagine they are to you:

  1. To change something about yourself, don’t just think about it. Practice it.
  2. Most things you want to change actually involve new language—new words and phrases. That’s because we are human beings. Talking (and listening) is what we do. It’s how we get things done, create new possibilities, and build relationships.
  3. Changing what you say can feel uncomfortable. In fact, if it’s something you haven’t said before, it should feel uncomfortable. That’s the whole point! If it was comfortable, you wouldn’t be changing. You would be doing what you always do.
  4. Your mood and intent matter as much as your words. That’s why it’s important to check in with your body by breathing and check in with your emotions by asking yourself, “How am I feeling?”
  5. Deliberate practice requires a lot of repetition. Practicing something five or ten times is a great way to start, but it’s only a start. Building skill requires hundreds of repetitions.

Whether at work or at home, in moments of joy or suffering, while trying to make history or simply making a life, you are what you say. And what you practice.

 

Please note: I reserve the right to delete comments that are offensive or off-topic.

  • David Drake

    I felt honored to read your story, Amiel. Thanks for sharing so openly and maturely about your experience. Great modeling of leadership….

  • Amiel Handelsman

    David, and I am honored that you read it and took the time to comment. Thank you.

  • Steven Johnson

    I appreciate the constant theme of deliberate practice. We often think it is associated with sports or other team events, but it has application to so many other things.

  • Amiel Handelsman

    Steve, agreed. So many applications.

  • Rachel Sheinbein

    Thanks for sharing and being vulnerable. I am so touched by this story. And excellent lessons on practicing. Also, I don’t know the exact statistic, but it has been shown that if doctors apologize they get sued significantly less frequently…

  • Amiel Handelsman

    I appreciate you saying that. I haven’t really shared any of this story online since the Oregonian ran something on us back in 2007, and I’m finding it easier to talk about the aftermath than the difficult experience itself. As for that statistic, good point. I’d heard that, too. Here’s one thing I found through a quick search:

    At the University of Michigan Health System, one of the first to experiment with full disclosure, existing claims and lawsuits dropped to 83 in August 2007 from 262 in August 2001, said Richard C. Boothman, the medical center’s chief risk officer.

    “Improving patient safety and patient communication is more likely to cure the malpractice crisis than defensiveness and denial,” Mr. Boothman said.

    (Full article: http://www.nytimes.com/2008/05/18/us/18apology.html?pagewanted=all&_r=0)