Teaching Doctors How to Say ‘I’m Sorry’

By | July 31, 2019

Seven years ago, on a hill overlooking Portland, I taught 15 medical students how to say “I’m sorry.” It wasn’t part of their curriculum or why I was invited to speak.

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

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

The invitation came from an OB/GYN known for being compassionate with patients, particularly those with difficult pregnancies. He heard about us through the grapevine. We knew him by reputation.

My initial inclination 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 felt comfortable shedding tears—crying, which rarely comes easily to me, had become my best form of relief.

My fear 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 turned a tragic situation into a full-blown trauma. I had just brought the error to the hospital’s quality council and been rebuffed. It was CYA.

The whole experience left me furious at our doctor, resentful toward the hospital, and disappointed with the health care system. 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.

Fortunately, over the years I’ve learned to temper my instinct of saying “no” by buying time. I told the doctor I would think about it.

This turned out to be a wise choice. There was no denying I was angry and at risk of blowing up in front of the students. However, deciding what I didn’t want wasn’t the same thing as deciding what I did want. So, the question arose: What is it you really want to have happen here?

Why I Taught Doctors How To Say “I’m Sorry”

The answer came quickly. It wasn’t to help students avoid making errors. 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. My goal 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 worse 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.”

For the first 40 minutes, I told our story and took questions. I cried, as did some of the students. And 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.”

Then I pivoted to the activity that had led me to show up.

“Now, I have a request for you,” I said. “I see that you have taken in this story. I imagine that you wish you could do something. Well, you can’t take away my emotions. They’re what they are, and I generate them. But you can humor a grieving father by doing something you probably have never been asked to do. Actually, let’s test that assumption. 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. “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 help me. Are you up for this?”

Heads nodded.

“OK, here goes.”

Practicing How To Say “I’m Sorry”

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 weird, but I appreciate it. And you’re 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.” Here the idea was not only to apologize, but to explicitly claim responsibility.

This was harder. It took longer for them to start, and several people stumbled over the words. But they did it.

Then, I asked them to repeat these phrases seven more times.

When they finished, I noted again that everyone was still alive. “Your eyes are open. Your brains still seem to work. In fact, some of you look more alert than when you walked in here.” That prompted chuckles.

Practice complete.

I closed by expressing my gratitude to the class for doing this unusual exercise and then made a final request. “Today, we practiced apologizing 13 times,” I said. “That’s a good start. However, to do this with patients when you’re stressed after making a mistake, you’ll have to practice this a lot more—a few hundred times more— before you graduate.”

Then I left.

Five Lessons From Learning How To Say “I’m Sorry”

  1. To change something about yourself, don’t just think about it. Practice it.
  2. Most changes involve new language: changing what you say. 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. 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. Breathe, check-in with your body, and asking yourself, “How am I feeling?”
  5. Deliberate practice requires a lot of repetition. 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.

Originally published on amielhandelsman.com. Used with permission.

The Good Men Project