Earlier this month, Sweden’s state epidemiologist, who has overseen the country’s coronavirus response, admitted that too many Swedes had died.
Dr Anders Tegnell told Swedish radio that the country’s controversial decision not to impose a strict lockdown in response to the Covid-19 pandemic resulted in too many deaths and acknowledged that more should have been done early on.
Sweden has counted over 4,500 deaths due to the virus while neighbouring Denmark has seen 580 deaths, Norway has had 237 deaths and Finland, 231. These other countries all imposed early restrictions.
As the man behind the policy, Dr Tegnell stood up and said if the Swedish government had known at the beginning of the pandemic what we know now, the strategy would have been different.
Notwithstanding the fact that the coronavirus pandemic is an unusually challenging time for those in decision making positions, it does not hurt to admit when you have got it wrong.
In medicine, this is more than just coming clean, it is a professional obligation—a duty of candour which essentially means being open and honest when something goes wrong.
This ethical duty includes telling patients when things have gone wrong, trying to put things right, and crucially, saying sorry. The importance of those three words “I am sorry” cannot be underestimated.
After all, it is hard to admit to ourselves when we have fallen short, and even harder to admit to patients that something has gone wrong and it is our fault.
Despite having systems with built in multiple checks so that if one person makes a mistake someone else on the team will pick it up, it remains inevitable that errors can and will happen.
These are not deliberate and should not be confused with negligence, which is failure to act in accordance with accepted standards. In fact, you can follow all the recommended guidelines, and mistakes can still happen.
Unfortunately, modern medical practice has now evolved to the point where only perfection is acceptable. Unfortunately, the reality is that expecting perfection is unrealistic.
And this is not easy to accept. As errors can have dire consequences, even life-threatening ones, just hearing someone say that doctors are all human anyway seems woefully inadequate.
I often feel that is a heavy burden to carry. After all, many incidents that are perceived as mistakes or errors, I believe are actually judgment calls.
For instance, in a complex surgical procedure, when there is an inadvertent complication despite my best efforts, it is not an unethical or moral offence but a judgement call. It seemed like the best decision at the time but turned out to be the wrong one.
Nevertheless, in spite of the many grey areas in medicine, it is important not to withhold any information and unreservedly apologise. When someone suffers because of a medical error, all the facts are needed and being transparent is the key. Saying how sorry you are goes a long way in diffusing a situation.
Many people not only want to hear exactly what happened and what is being done to deal with any harm caused, but also what will be done in the future to prevent someone else from being harmed.
Equally important is being aware that saying how sorry you are does not mean that you are admitting legal liability. This is known to be set out in legislation, but even the NHS Litigation Authority in the UK advises that saying sorry is ultimately the right thing to do.
In the end, having an open and trusting relationship between doctor and patient is the goal, and an apology has the power to restore confidence even if forgiveness is not guaranteed.