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Apology, disclosure and trust

January 23, 2013


By: Ahmed Afaal, MD

Over the years, many Maldivians travel abroad to seek health services. Many a time, these people seek services abroad for those that are readily available in the country.

But why?

I believe that this is due to the fact that people have lost trust in the system.  We need to go through a shift in paradigm in order gain the trust of the people. The first step towards this shift is to start believing that we have a problem.

In my interactions with quite a lot of patients, issues that they have raised are not really medical. Following are views from patients that I have been told many a time.

  • Patients believe and know that no health system is perfect. They also believe that there is a high risk in any medical intervention and of course, doctors and other health professionals can make mistakes. They could sometimes be negligent as well. Most patients do understand this fact.
  • Most patients think, and rightly so, that the health providers are not willing, or are reluctant to share with patients any mishaps or complications that happen during a procedure. They believe that they should know and yes they should. A few patients told me that there is simply no disclosure at all.
  • No one among the healthcare providers cares to offer an apology let alone compensation for any mishaps or complications due to the provider’s mistake. Most people will accept an apology, a genuine apology.
  • Hence, people think that the healthcare settings in the country are clod places, not open, no communication, no dialogue and to a large extent no participation of the patient in care. All these factors, over the years have lead people to loose trust in the system.

Recently, I posted the following question on both my Facebook and Twitter accounts just as a small assessment of how people feel about medical mishaps.

In an event of a medical error or complication, what would you want or expect your doctor to tell you?


Most of the responses revolved around wanting to know what happened, wanting and apology and empathy. Following are some of the responses received.

Doctors, medical staff and hospitals never say sorry or apologize in such an event. Experienced personally few times.

Apology would be a good start. It always calms the atmosphere. Explain the current state of the patient and what are the possible options to overcome the said complication. Constantly keep the by standers in the loop.

When you're a patient, you trust you're in good hands, but even the best doctor or nurse can make a mistake on you. Just learn how to say " I am sorry "

In the event of a complication, the truth, and in the event of an error, an apology.

As you can see, this is where we healthcare providers have failed to create the link between the patients. And this is where we can start to build that trust with the patients.

I recall a conversation that I had with a very prominent local doctor on this matter. We had a discussion on apologizing and compensation. His response to me was, when you apologize, you are accepting your fault. You cannot do that can you?

With a mindset like that, we will never be able to get the trust and respect of the very people we serve everyday. I believe we should start to work on this, be bold, be accountable, be open and be honest. How the events unfold will not let us down.


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