Over the past couple of months many of you may have heard about a new initiative in malpractice legislation. This innovation is responsive to the notion that patients would be less likely to sue if we said to them, “Yes, an error was made, we regret it but please accept our apology”. The intent then is that the patient would get some measure of satisfaction from an admission that doctors are human, too. They would acknowledge by accepting the apology that an untoward result was occasioned by unfortunate error not malicious or incompetent action. The hope would be that the impetus to sue would be reduced. Recent articles in the Wall Street Journal and Time Magazine have played up this initiative. In this discussion I will lay out some arguments that lead to the conclusion that an apology is a great risk for radiologists particularly [1].

The stimulus for using apology as a technique to minimize malpractice stems, in large measure, from the famous report in the Institute of Medicine with which I am sure most of you are familiar. It concluded that up to 100,000 deaths per year in hospitals are due to errors made by doctors and other healthcare workers. In 2001 JCAHO demanded safety standards requiring the disclosure of unanticipated outcomes. They further clarified that statement in 2004 with the regulation that patients, and when appropriate their families, be informed about untoward, unanticipated events. Furthermore, when questions arise about the breadth of treatment, a JCAHO-accredited organization must tell patients when harm comes to them in respect to their diagnosis and their therapy. Now, if JCAHO demands that we should tell patients when our actions induce injury, illness, discomfort or worse, one might conclude that we are further exacerbating the possibility of malpractice suits since we acknowledge that a deviation from expected results has occurred. Nonetheless, disclosure of harmful outcomes is both a regulatory requirement and, one might argue, an ethical obligation. Yet, only three states have passed laws mandating written disclosure of adverse or bad outcomes to patients and families, Pennsylvania, Nevada and Florida.