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In this episode, we cover:

  • What to actually say when a patient asks, “Doctor, was this your fault?”
  • How to use empathy without making legal admissions.
  • A simple framework to handle five of the toughest conversations after something goes wrong.

 

Key Takeaway Quote:

“Patients don’t expect perfection. They expect honesty. Sometimes the most trust-building thing you can say is, ‘I don’t know yet, but I’ll come back when we do.’” – Dr. Barbara Hales

 

Connect with Barbara Hales: 

 

TRANSCRIPT

The Five Difficult Conversations After Something Goes Wrong

Dr. Barbara Hales 0:02

Doctor, was it your fault? Your patient looks you directly in the eye and asks, “Doctor, was this your fault? What do you say? You have about three seconds before the silence starts saying something for you. Hello, everyone, and welcome back to Marketing Tips for Doctors. In our last episode, we talked about something I called the transparency paradox-the idea that when something goes wrong, physicians may become quiet and guarded, because we’re afraid that talking will increase our liability. But to the patient, that same silence can feel like we’re hiding something. So today, we’re going one step further because it’s easy for me to tell you: communicate with your patient, be transparent, show empathy. But when you’re actually standing in front of an upset patient or frightened family member, those aren’t the words you need. You need to know what I actually say. Today, we’ll walk through five of the most difficult conversations a physician can have after something goes wrong. I’ll show you what you may be tempted to say, why it can cause problems, and what you might say instead. And before we begin, an important reminder: this is about communication, not legal advice. Every adverse event’s circumstances are different. State laws differ, and your hospital malpractice carrier or risk management team may have specific procedures you need to follow, so use this episode to think differently about communication, not as a substitute for the policies and professional advice that apply to your particular situation. Now grab your coffee because we’re starting with the question no physician wants to hear: Doctor, was this your fault? Imagine that you’ve just finished explaining to a patient that something unexpected happened during her procedure. She looks at you and asks, “Was this your fault? Your first instinct may be to defend yourself. No, this is a known complication. Or maybe you go in the opposite direction. Yes, I made a mistake. But what if you don’t know yet? That’s the key. Don’t answer a question you don’t yet have the facts to answer. You don’t have to become evasive, and you don’t have to speculate. You can say, “I understand why you’re asking me that right now. I don’t know exactly why this happened. We’re reviewing what occurred, and I don’t want to give you an answer that may turn out to be wrong. As soon as we know more, we’ll talk about it. That’s honest. You didn’t run from the question. You didn’t blame someone else, and you didn’t conclude before you had the facts. There is tremendous power in being able to say, “I don’t know yet. Doctors aren’t always comfortable saying that. We’re supposed to have answers. Patients come to us because we have answers. But when you genuinely don’t know something. Pretending otherwise doesn’t make you look more competent. It makes you less trustworthy when the facts eventually come out. The important word is yet. I don’t know can sound like a dead end. I don’t know yet, but we’re finding out tells the patient, “I’m still here. Conversation number two: something definitely went wrong. Now, let’s change the situation. This time, you know an error occurred. Perhaps the wrong medication was administered. Maybe a test result wasn’t followed up. Maybe something broke down somewhere in the system. Again, there’s a temptation to become clinical. An adverse medication event occurred. That may be technically accurate, but imagine. As the patient hearing it, I know an adverse medication event didn’t happen to a spreadsheet. It happened to me. This is where medicine sometimes hides behind language. We use terms like unexpected outcome, adverse event, communication failure. Those phrases may be long in reports, but you’re not talking to a report. You’re talking to a person. So use human language. Something happened that shouldn’t have, and I’m sorry you’ve had to go through this. Then tell the patient what you know, not what you assume, not what you heard in the hallway, not what you think is responsible. What you know, and then tell them what happens next. We are reviewing exactly how this occurred. We’re addressing the immediate problem. We’ll keep you informed as we learn more. That last sentence matters because one of the worst things you can do is have one compassionate conversation and then disappear. Trust isn’t rebuilt in one meeting.

Dr. Barbara Hales 6:20

Sometimes it’s rebuilt in the second meeting and the third. Let’s imagine a physician will call Dr. Miller. One of his patients has a significant complication. Dr. Miller has an excellent conversation with the family. He sits down. He listens. He expresses concern. He promises that the hospital will investigate and that he’ll come back when he knows more. The family feels reassured. Three days go by, nothing. Five days, nothing. The family starts calling. They’re transferred from one department to another. Nobody seems to know anything. Now think about what happened. Dr. Miller’s original conversation was actually good, but his failure to follow through changed its meaning. What originally sounded like “I’m going to find out what happened” now sounds like “I told you that so you’d stop asking questions. That’s why one of the most important things you can say after something goes wrong is also one of the simplest. I’ll come back, but only say it if you’re actually going to come back. Conversation number three: the patient is angry. Now things get harder. The patient isn’t calmly asking questions. He’s furious. You people almost killed me. This hospital is incompetent. You don’t care what happens to me. Every instinct in you wants to correct him. We did not almost kill you. That’s not what happened. You’d unders. You don’t understand the medical situation, and perhaps technically you’re right, but right now being right isn’t necessarily going to help you, because underneath anger there is often something else: fear, loss of control, pain, a feeling that nobody is listening. So before you correct the facts, acknowledge the emotion. You might say, “I can see how angry and frightened you are, and I understand why you want answers. Notice what you did not say. You didn’t agree that the hospital was incompetent. You didn’t accept blame for something you didn’t do. You acknowledged the patient’s experience. There is a big difference between saying you’re right, we almost killed you, and saying I can understand why you’re frightened and angry. One is the conclusion about what happened. The other is empathy. Physicians sometimes avoid empathy because we’re afraid the patient will interpret it as an admission. But empathy isn’t a confession. It’s recognition that another human being is having a difficult experience, and sometimes that’s the first thing a person needs before they’re capable of hearing anything else you have to say. There’s one sentence that is almost guaranteed to make an angry patient angrier. You need to calm down. Has telling an angry person to calm down ever actually made them calm down? Probably not. It usually communicates that your reaction is the problem. Instead, try. I can see that you’re upset. Tell me what concerns you most right now, and then listen. Don’t start constructing your defense while they’re still speaking. Don’t interrupt after the first inaccurate statement. Let them tell you what they’re actually worried about. You may discover that the thing you’re preparing to defend isn’t even the thing they’re most upset about. Conversation number four: Why didn’t anyone tell me? This one is painful because sometimes the patient’s complaint isn’t primarily about the medical outcome; it’s about communication. Why didn’t anyone tell me? Why did I have to find this in my medical record? Why did three different people give me three different answers? Why did nobody call me? This is where defensiveness can creep in very quickly. I thought the nurse told you. The office called twice. The result was available in the portal. Stop. Maybe all of those things are true, but before explaining the system, recognize what the patient experienced. I can understand why finding out that way would be upsetting. You should have had a clear explanation of what was happening. Then explain what you know, and if there was a communication breakdown, acknowledge it. Patients don’t expect every medical outcome to be perfect. Medicine is not perfect. Human bodies are not perfect. Technology is not perfect. Doctors are not perfect, but patients have every reason to expect us to communicate with them honestly, and this is where the conversation starts moving beyond malpractice, because poor communication damages something much bigger: trust. Conversation number five: When an apology is appropriate, now we come to the words doctors have traditionally been afraid to say. I’m sorry. As we discussed in the last episode, apology laws vary from state to state.

How to Handle the Conversation

Dr. Barbara Hales 12:53

Some may protect certain expressions of sympathy while not protecting admissions of fault. Your organization’s procedures and your individual circumstances matter. So I’m not giving you a legal formula. I’m talking about human communication. If someone has experienced suffering, you can acknowledge suffering. I’m sorry you’ve had to go through this. If an investigation has established what happened, then the appropriate disclosure process may involve a more specific apology and explanation, and that’s where working with your institution or risk management team becomes important. But don’t make the mistake of thinking that because you need to choose your words thoughtfully, you need to stop behaving like a human being. There’s a difference between being careful and being cold. Now let’s put it together. Imagine you’re walking into a patient’s room after an unexpected event; you know something happened. You don’t know yet exactly what. Here’s what a thoughtful conversation might sound like, Mrs. Green. I want to talk with you about what happened earlier today. There was an unexpected problem with your medication. Right now, our priority is making sure you’re all right, and we’re monitoring you closely. I’m sorry you’ve had to experience this. We’re reviewing exactly what happened. I don’t have all of those answers yet, and I don’t want to speculate or give you information that might turn out to be wrong. As we learn more, we’ll share that information with you. What questions do you have for me right now? Notice how ordinary those words are: no corporate language, no. No medical jargon, no elaborate speech. You acknowledge, you empathize, you explain, you admit what you don’t know, you explain what happens next, and you invite questions. That’s communication. But what if they ask the question again? Fine, doctor. But I asked you a question. Was this your fault? Now we’re right back where we started, and this is where many physicians panic. You don’t have to look at the patient. Don’t look at the floor. Don’t start shuffling papers and say, “I understand why you want an answer to that. I would want an answer too. Right now, we don’t know enough for me to tell you exactly why this happened. I don’t want to guess. When we know more, we’ll discuss it with you. That’s not avoiding the question. It’s refusing to pretend you know something you don’t. But here’s the other side: if the investigation eventually determines that an error occurred, transparency means the conversation should not simply disappear. You come back because the promise wasn’t. I’ll talk to you until this becomes uncomfortable. The promise was we’ll tell you what we learn.

The Second Victim and Five Phrases to Remember

The second victim, we don’t talk about. There’s another reason these conversations are so difficult. The physician may be suffering too. When something goes wrong with one of our patients, we don’t simply clock out and forget about it. We replay it. What did I miss? Could I have prevented this? Should I have ordered another test? Should I have noticed something earlier, and then we have to walk into the next room and see the next patient? That emotional burden can make us withdraw from the very patient we need to communicate with, not because we don’t care. Sometimes because we care so much that we don’t know what to say. That’s why having a framework helps. When your emotions are telling you to retreat, the framework reminds you: acknowledge, empathize, explain. Don’t speculate. Follow up. You don’t need the perfect speech. You need to stay present. Five phrases to remember. So, if you ever find yourself standing outside that patient’s room, wondering what you’re going to say, remember these five phrases. I’m sorry you’re going through this. Here’s what we know right now. I don’t know yet. We’re looking into what happened, and perhaps the most important. I’ll come back when we know more. Then come back. Those aren’t magic words. They don’t guarantee that a patient won’t become angry. They don’t guarantee that somebody won’t sue, and they don’t replace appropriate lethal or risk management guidance. They’re simply ways to communicate like one human being talking to another during an extraordinarily difficult moment.

Why Trust Matters to Your Practice

Dr. Barbara Hales 19:09

Why does this matter to your practice? You might still be wondering why spending two episodes of marketing tips for doctors talking about what happens when medical care goes wrong matters, because your reputation isn’t built by your website; it’s not built by your logo; it’s not built by your Facebook page.

Those things communicate your reputation. They don’t create it. Your reputation is created in moments. The moment you return the frightened patient’s phone call, the moment you sit instead of standing at the door, the moment you listen instead of becoming defensive, and yes, the moment something goes wrong and your patient watches to see what you do next. Patients don’t expect physicians to control everything that can happen, but they do remember how we made them feel when they were frightened and vulnerable, and that memory may last much longer than anything you put on your website. One last question. Let’s return to where we started. Your patient looks you in the eye and asks, “Doctor, was this your fault? You don’t need to panic. You don’t need to run. You don’t need to speculate. You can say, “I understand why you’re asking. I don’t know yet. We’re going to find out, and I’ll talk with you when we know more. And then you do something incredibly important. You keep your word, because trust isn’t created by having all the answers. Sometimes trust is created by being honest enough to say you don’t have them yet. Now, there’s one situation we haven’t really tackled today. What happens when the patient is not simply asking questions? What happens when they’re furious? They’re raising their voice. They’re threatening to leave your practice. They’re threatening a terrible online review. Maybe they’re even saying, “I’m going to sue you. What do you say then? That’s what we’re going to talk about in our next episode, the angry patient, because one badly handled conversation can turn frustration into a broken relationship. But handled correctly, it may become an opportunity to rebuild trust. So make sure you subscribe to Marketing Tips for Doctors so you don’t miss it. And if you know another physician who’s ever wondered What on earth am I supposed to say when something goes wrong, send them this episode because every week we’re talking about practical ways to build stronger practices, stronger patient relationships, and greater trust, and remember, you’re one tweak away from greatness.