Lawmakers in eight states in the US are considering bills that would allow physicians to apologize when things go wrong without having to fear that their words will be used against them in court.
At least 27 other states have already passed similar laws, nearly all of them in the past four years, according to the American Medical Association.
The wave of "I'm sorry" laws is part of a movement in the medical industry to encourage doctors to promptly and fully inform patients of errors and, when warranted, to apologize. Some hospitals say apologies also help defuse patient anger and stave off lawsuits.
Apology laws from state to state. In Arizona, Connecticut, Idaho, Maine and 11 other states, doctors can safely apologize to or commiserate with patients or their families about an undesirable or unexpected outcome, according to the AMA.
A law in Vermont exempts only oral statements of regret or apology, not written ones. Illinois gives doctors a 72-hour window to safely apologize after they learn about the cause of a medical mishap.
Boston-based ProMutual Group, which insures 18,000 doctors, dentists and health care facilities in the Northeast, warns its clients against apologies that admit guilt -- even in states that have laws protecting doctors who say they are sorry.
But some malpractice-reform advocates say an apology can help doctors avoid getting sued, especially when combined with an upfront settlement offer.
The idea defies a long tradition in which doctors cultivated a godlike image of infallibility and rarely owned up to their mistakes.
Research has actually shown that being upset with a doctor's behavior often plays a bigger role than the error itself in patients' decisions to sue.
The softer approach has now begun to appear in some medical school courses too. It is drawing interest as national attention has turned to reducing both medical errors and the high cost of malpractice insurance, which has been blamed for driving doctors out of business.
Doctors' often-paternalistic relationship with patients is giving way to an understanding that "it's OK to tell the patient the whole story," said Dr. Paul Barach, an anesthesiologist and patient safety researcher at the University of Miami. It is "a huge sea change as far as our relationships with patients."
The hospitals in the University of Michigan Health System have been encouraging doctors since 2002 to apologize for mistakes. The system's annual attorney fees have since dropped from three million to dollars to only one million. Malpractice lawsuits and notices of intent to sue have fallen from 262 filed in 2001 to about 130 per year, said Rick Boothman, a former trial attorney who launched the practice there.
The "say-you're-sorry" movement has been prompted in part by emerging evidence about the scope of medical errors. An Institute of Medicine report in 1999 said mistakes kill as many as 98,000 hospitalized Americans each year.