Owning Up

The comment thread in a previous post of mine has been hijacked by a discussion about lying; doctors and pharmacists and patients all castigating each other over lying about whether or not med refills had been called in, left on voicemail, faxed over; whatever. Aside from the fact that this is a non-issue in my office, as we always do our best to respond promptly to all such requests, the discussion got me thinking.

We're not talking about big lies here; just little, face-saving ones, like when you forget to call in the script but tell the patient you did -- and then hang up and call it in right then. Or telling a patient that you tried to call them back and couldn't get through when in fact you just forgot. Or telling a patient that the nurse forgot to draw the blood when you only decided to do a test after the patient had left. Or that the file room lost the results when you just never got around to calling the patient back with them promptly.

Why do people do this? If they think they're doing it to avoid looking bad to their patients, then all I can say is that they are dead wrong!

Not only is lying wrong -- little ones as much as big ones -- but it makes you look like a jerk, completely defeating the purpose of saving face. Frankly, I'm shocked at how often I hear these kinds of transparent little lies from doctors (and their staffs, though as far as I'm concerned, it's the same thing) and I disapprove. Heartily.

And I never do it. I just don't. I don't mean that my staffers and I never make mistakes, but that we don't lie about it when we do. We own up to it; we apologize.

An apology has three parts:

1. Acknowledgment that one has made a mistake,
2. Expression of regret that the mistake was made, and
3. Correcting the mistake as quickly as possible.

All three part are necessary. Here's why:

This is an "apology" without the acknowledgment:

I don't know what I did wrong, but whatever it is, I'm sorry.

What the hell does that mean?

Here's what it looks like without the regret:

Yeah, I know I forgot your birthday. I'll pick up a card on the way home.

That's not going to cut it.

Then there's this:

We forgot to call back with your results. Sorry about that.

So tell me about the freaking results already!

Offering a sincere apology, complete with all three parts, may seem complicated and time consuming, but it's not:

Patient: You never called in my refill.

Answer:

You're right, we didn't. [acknowledgment]
I'm so sorry about the oversight. [regret]
We'll call it in right now. (Then do it!) [correction]

The first thing, of course, is to see that mistakes don't happen very often. If they do then you have far more of a problem on your hands than can be solved by mastering the form of the apology. There are other kinds of situations, though, for example when you research a patient's condition and change your mind about what you want to do (order a different test; prescribe a different med, etc.) that I see many physicians treating like "mistakes;" at least in terms of telling those little face-saving lies.

Once more, I claim that any approach that includes lying will backfire.

I once heard a doctor try to convince a patient that they had discussed performing an MRI during an office visit, when in fact the doctor had decided it wasn't necessary at the time, but had later changed his mind. I found myself squirming, listening to him try to get the patient to believe she was mistaken about what had transpired during the visit. Although he probably thought he was saving face by making the patient think he couldn't possibly have made a mistake, I know if I were that patient I would have hung up the phone and said, "What an asshole."

Here's what I do when this happens to me: I call the patient and I say, "I looked this up," or "I called another doctor about your case and he suggested I do something different," or "I thought about it some more," or even "I changed my mind," and then explain what I want to do differently from what we'd discussed in the office. Guess what: no one has ever thought less of me as a result of receiving that call. Here's why: admitting when you're wrong (or when you change your mind) enhances your credibility for when you're right; hopefully the vast majority of the rest of the time.

There's a lot to be said for owning up.