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In this episode, Barbara discusses:

  • The myth that saying “I’m sorry” always increases malpractice risk
  • How silence and defensiveness can increase mistrust and suspicion in patients and families
  • The Candor (CANDOR) approach: Communication and Optimal Resolution—emphasizing timely communication, investigation, disclosure, empathy, apology (when appropriate), learning, and fair resolution
  • Examples of three physicians (Mary’s doctor, Dr. Thompson, Dr. Rodriguez) that contrast silence vs. transparent communication
  • The role of apology laws, and why doctors must know state law, organizational policy, and malpractice-carrier guidance
  • A practical 4‑step communication framework after an adverse event:
    1. Acknowledge what happened
    2. Express empathy
    3. Don’t speculate
    4. Explain what happens next and follow through
  • Why this belongs on a marketing podcast: reputation, relationships, trust, and what patients say about you when you’re not in the room
  • The impact on physicians’ own emotional well‑being and the importance of supporting clinicians after adverse events
  • Her core message: phrases like “I’m sorry,” “I don’t know yet,” “We’re investigating,” “I’ll come back,” and “We’ll work to make sure this does not happen again” can be words of integrity, not weakness.

Key Takeaways:

“Silence after something goes wrong often increases mistrust, while honest, empathetic communication (“I’m sorry,” “I don’t know yet,” “We’re investigating,” “I’ll come back”) can build trust rather than automatically increasing legal risk”

 

Connect with Barbara Hales: 

 

TRANSCRIPTION:

 

 

The Most Dangerous Word in Medicine: “Sorry”

Dr. Barbara Hales 0:00:31

The most dangerous word in medicine, sorry, the word that can make a physician cringe. Sorry, not because doctors don’t care. Quite the opposite. Hello, everyone, and welcome back to Marketing Tips for Doctors. Most physicians went into medicine because we care deeply about our patients, but somewhere during our training, many of us absorbed another lesson: When something goes wrong, be very careful what you say. Don’t speculate. Don’t admit anything. And whatever you do, don’t say something that could sound like you’re admitting fault, because you might get sued. But what if that isn’t the whole story?

Mary’s Story & The Birth of Suspicion

Dr. Barbara Hales 02:00

What if the instinct to protect ourselves by becoming quiet, distant, and guarded can sometimes accomplish exactly the opposite? What if silence makes an already frightened or angry patient wonder, “What aren’t they telling me? That’s what we’re talking about today. I call it the transparency paradox. And grab your coffee because this one might make you rethink something doctors have been hearing for decades. When something goes wrong, let’s imagine a patient named Mary. Mary goes into the hospital for what she believes will be a relatively straightforward procedure. Unfortunately, she develops a serious complication. Her family is frightened. They have questions. What happened? Was this expected? Did somebody make a mistake? Is Mary going to be all right? And perhaps most importantly, why isn’t anyone talking to us?

The physician is frightened too. Maybe he doesn’t yet know exactly what happened. Maybe risk management has become involved. Maybe he’s terrified that one poorly chosen sentence will become Exhibit A in a malpractice lawsuit. So he keeps the conversation brief. He sticks to clinical facts. He avoids discussing what might have happened, and he certainly doesn’t apologize. From his perspective, he’s protecting himself. But let’s look at that interaction from Mary’s perspective. Something happened to me. Nobody will explain it. Everyone suddenly seems guarded. My doctor barely looks me in the eye. Maybe they’re hiding something, and now we have something that didn’t necessarily exist before: suspicion. That is the paradox. The physician’s silence was intended to decrease legal risk, but emotionally, that same silence may increase mistrust.

The Myth of “Never Say You’re Sorry”

Dr. Barbara Hales 05:00

The myth. There’s a persistent myth in medicine that goes something like this: Never say you’re sorry because apologizing is admitting liability, and like many myths, there’s a tiny bit piece of truth buried inside something much more complicated. There is an enormous difference between saying “I’m very sorry this happened to you, and making a definitive statement about negligence before the facts have even been investigated. That’s why I’m not suggesting that doctors become their own attorneys. I’m not an attorney, and this episode is not legal advice. The laws governing apologies and their admissibility vary from state to state, and your hospital practice insurer and risk management team may have specific procedures you need to follow.

CANDOR: Communication and Optimal Resolution

Dr. Barbara Hales 07:00

But here’s what I do want physicians to understand. Passion and transparency are not synonymous with recklessness, and we now have organized approaches to adverse events that are built around that distinction. One of the most important is called candor, C-A-N-D-O-R. That stands for Communication and Optimal Resolution. It was developed by the Agency for Healthcare Research and Quality. Instead of the old-fashioned approach, sometimes described as deny and defend, Candor emphasizes timely communication, investigation, disclosure, empathy, apology when appropriate, learning from the event, and fair resolution.

Think about how different those two philosophies feel to a patient. One says, “Protect the institution. Say as little as possible. Wait for the lawyers. The other says something happened. We’re going to find out what happened. We’re going to communicate with you. We’re going to take care of you, and we’re going to learn from this. That’s a very different experience.

Case Study: Dr. Thompson and the Medication Error

Dr. Barbara Hales 09:00

Now let’s imagine another physician. We’ll call her Dr. Thompson. A medication error occurs. The wrong dose reaches her patient. Thankfully, the patient recovers. Dr. Thompson is devastated. She walks into the room and immediately says, “This was completely my fault. I made a terrible mistake. There was no excuse for it. Now, emotionally, we understand why she said it. She feels terrible, but there’s another problem here. At this point, nobody has completed the investigation. Maybe the electronic ordering system displayed the wrong dose. Maybe the pharmacy verification failed. Maybe there were two medications with nearly identical names. Maybe five different safeguards failed, or maybe Dr. Thompson really did make an error. We don’t know yet, and that’s an important distinction.

Transparency does not mean guessing. It does not mean assigning blame before the facts are known, and it does not mean making promises you may not be able to keep. In fact, one of the principals in formal disclosure programs is very simple: tell patients what you know, don’t speculate about what you don’t know.

What Patients Actually Want After Harm

Dr. Barbara Hales 11:00:

Imagine how much better this might sound, mr. Jones. Something happened with your medication today that we did not expect, and I’m very sorry that you’ve had to go through this. Right now, our priority is taking care of you. We’re also investigating exactly what happened. I don’t want to speculate or give you information that may turn out to be wrong, but I promise that we’ll keep you informed as we learn more. Notice what’s missing: running away, defensiveness, blaming somebody else, and speculation. But notice what’s also there: humanity.

What patients actually want. When patients have been harmed, we sometimes assume their first thought is, “How much money can I get? But that is an extraordinarily cynical way of looking at people. Patients and families often want answers. What happened? Why did it happen? What are you going to do about it? And perhaps most importantly, could this happen to somebody else? Think about that last question. A patient who has just experienced something terrible may still be thinking about the next patient. They don’t want another family sitting where they’re sitting. That tells us something important. Sometimes resolution is not only about money. It’s about acknowledgement. It’s about answers. It’s about accountability, and it’s about knowing that something will change because of what happened.

University of Michigan & Challenging Assumptions

Dr. Barbara Hales 13:00

Here is the University of Michigan experience. This isn’t just a feel-good theory. One of the most frequently discussed examples came from the University. University of Michigan Health System. They developed an approach that moved away from automatically fighting every claim. When care was appropriate, they defended it. But when their investigation found that inappropriate care caused harm, they disclosed what happened and sought resolution, including compensation when appropriate. Researchers subsequently examined what happened to malpractice claims and costs, and here’s why that matters. The nightmare scenario many physicians imagine is if we start admitting that things went wrong, everybody will sue us. But that wasn’t what happened. The experience helped challenge the assumption that openness automatically creates more liability, and later research involving communication and resolution programs at other hospitals has also provided reason for optimism.

That doesn’t mean apologize and nobody will sue you. Please don’t leave this episode telling people Dr. Hale said that. That’s not what the evidence says. It means something much more interesting, transparency when it is part of a thoughtful system of communication, investigation, apology, and resolution, does not appear to create the inevitable legal disaster physicians have traditionally feared, and in some settings, liability outcomes have actually improved.

Case Study: Dr. Rodriguez and Rebuilding Trust

Dr. Barbara Hales 15:00

Now let’s meet our third physician, Dr. Rodriguez. Performs surgery on a patient we’ll call Robert. Robert experiences an unexpected injury. This time, instead of disappearing, Doctor Rodriguez sits down with Robert and his wife. Not standing at the door, not checking his phone, not speaking in medical jargon. He sits down. He looks at them, and he says, “Something happened during your surgery, that we need to investigate. I’m sorry that you’re going through this right now. My priority is taking care of you. We’re going to review exactly what happened, and as we learn more, we’ll share that information with you. Then he does something equally important. He comes back because disclosure is not one conversation. As more information becomes available, Robert and his wife are updated. Eventually, the investigation identifies an error. Dr. Rodriguez and the organization explain it. They apologize. They explain what should have happened, and then they explain what they’re changing so that another patient is less likely to experience the same thing.

Now, does that guarantee Robert won’t sue? Absolutely not. But compare Robert’s experience with Mary’s. Mary experienced silence. Robert experienced communication. Mary wondered what people were hiding. Robert knew an investigation was underway. Mary’s trust Deteriorated. Robert was treated like a partner who deserved answers. That difference matters.

The Transparency Paradox & Apology Laws

Dr. Barbara Hales 17:00

Here’s the real transparency paradox: Doctors sometimes think if I reveal less, I’m safer. Patients may think if you’re revealing less, there must be something you’re hiding. That’s the paradox, and there’s another side to it. Transparency does not mean telling patients everything you think might have happened. It means being honest about what you know, honest about what you don’t know and committed to finding the answers-that’s a very different thing. You can say, “I don’t know yet. Those may actually be four of the most trustworthy words in medicine, provided you followed them with, “But I’m going to find out what about apology laws. Now we have to talk about something called apology laws. Many states have enacted laws that provide some protection for certain statements physicians make after adverse events, but. And this is a big but; they’re not all the same. Some laws may protect expressions of sympathy, such as “I’m sorry you’re going through this. That doesn’t necessarily mean they protect a statement such as “I made the mistake that caused this.

The specifics vary by jurisdiction, so please don’t listen to this podcast and decide that tomorrow you’re going to create your own disclosure policy. Know your state’s law, know your organization’s policy, know what your malpractice carrier recommends and involve risk management when appropriate, but don’t confuse being legally thoughtful with being emotionally absent. Those are two very different things.

A 4‑Step Framework: What to Say When Something Goes Wrong

Dr. Barbara Hales 19:00

What should a physician actually say? So let’s make this practical. Something unexpected has happened. You’re standing outside the patient’s room. Your stomach is in knots. What do you do? First, take care of the patient’s immediate medical needs. Obviously, then get the appropriate people involved according to your organization’s procedures. But when you speak with the patient, remember four things. Number one, acknowledge what happened. Don’t make the patient drag information out of you. Two, express empathy. I’m sorry you’re going through this. Human beings need to hear that another human being recognizes their suffering. Number three, don’t speculate. If you don’t know why something happened, say so. I don’t know yet is better than giving an explanation that turns out to be wrong, or tell them what happens next. We’re investigating this. We’ll keep you informed. Here’s what we’re doing for you now, and then do what you said you were going to do, because transparency without follow through is not transparency; it’s public relations.

Why This Is a Marketing Issue: Reputation, Relationships, Trust

Dr. Barbara Hales 20:00

So you may ask, why does this belong on a marketing podcast? You may be wondering, Barbara, this is marketing tips for doctors. Why are we talking about medical errors and malpractice, because marketing is not just advertising. Marketing is reputation. Marketing is relationships. Marketing is what your patients say about you when you’re not in the room, and above all, marketing is trust. Your reputation is not built only when everything goes beautifully. Sometimes your reputation is built during the worst moments of a patient’s experience. Any doctor can appear caring when the treatment works perfectly and the patient is delighted. The real test of a relationship comes when something has not gone according to plan. Do you disappear? Do you become defensive? Do you blame the nurse, the hospital, the pharmacy, or the computer? Or do you sit down, look your patient in the eye and say, “I’m here. I’m sorry this happened. Here’s what we know. Here’s what we don’t know yet, and here’s what we’re going to do next. That patient may never forget that conversation.

Doctors Are Human Too & The Core Message

Dr. Barbara Hales 21:00

And doctors are human too. There’s another person in this story whom we haven’t talked much about: the physician. When something goes wrong, doctors can be devastated. We replay the case in our heads. What did I miss? What could I have done differently? Was this my fault? We may lose sleep. We may question our competence, and at the same time, we’re expected to walk into the next patient’s room and function as though nothing happened. That’s one reason I think silence can be so damaging on both sides. The patient is isolated, and the doctor is isolated. Interestingly, programs such as Candor don’t focus only on the patient and family. They also recognize the importance of supporting the clinicians and staff involved in adverse events, because you can believe in accountability and still have comparative. For the people involved, those aren’t opposites.

So, does saying sorry prevent lawsuits? Here’s my answer: not necessarily. And anyone who promises you that it does is oversimplifying a very complicated issue, some patients will sue regardless of how compassionate the doctor is. Some events involve serious negligence. Some injuries are catastrophic. Some families will need compensation, and sometimes litigation will be unavoidable, but that’s not the question we should be asking. The better question is, does treating an injured patient with honesty, empathy, communication, and respect automatically increase our legal risk? The evidence from well-designed communication and resolution programs tells us that the answer is not the simple yes that generations of physicians have feared, and that matters because fear has shaped the way medicine communicates after something goes wrong. Maybe it’s time we questioned that fear.

The one thing I want you to remember, if you remember nothing else from today’s episode, remember this: sometimes the words doctors are most afraid to say are the very words patients most need to hear. I’m sorry. I don’t know yet. We’re investigating. I’ll come back. We’ll tell you what we learned, and we’ll work to make sure this does not happen again. Those are not necessarily words of weakness. They can be words of integrity, and in medicine, integrity is one of the most powerful forms of trust we have. So the next time somebody tells you never apologize, you’ll get sued. Remember the transparency paradox. Sometimes what feels like protection can create distance, and what feels like vulnerability can begin rebuilding trust. If today’s episode made you rethink something you’ve been taught about medicine, share it with another physician, because every week on Marketing Tips for Doctors, we talk about practical ways to build stronger practices, stronger relationships, and greater trust with the patients we serve, but that leaves us with a very important question: If silence is not the answer, what exactly should you say when something goes wrong. That’s what we’re going to tackle in the next episode, including the words I would use and the words I would never use. So make sure you’re subscribed because you don’t want to miss that conversation. Till next time.

Outro – Subscribe & Resources

0:23:20 Narrator: Thanks for listening to Marketing Tips for Doctors. If you like the podcast, please subscribe, rate, and review. Press the subscribe button so you never miss an episode, and tell your friends about the show. Join us on marketingtipsfordoctors.com for replays and more resources to help grow your practice, strengthen your brand, and dominate your field. Remember, you are one tweet from greatness.