Many years ago, I was handed an apology on a sheet of paper. The note read, in large flowery writing using a black fountain pen on the top two lines of a faintly lined sheet of A4, something like this: ‘Dear Lisa, we apologise if you feel our treatment of you was below standard. Yours, (CEO).’ That was it.

I read it and then I read it again. It was so poorly worded, it felt pointless. I paused and didn’t say anything for a while. I then calmy tore the apology up into smallish pieces and placed it neatly in a tiny pile on a large boardroom table, with many bewildered senior faces looking back at me. They thought I would like/appreciate their apology. They had thought it would help. Sadly, however, they had not thought once about how making the 'apology' might make me feel. All the 'apology' had done was inflame the already delicate situation and things had gone from bad to worse.

This flashback and those feelings, mainly disbelief, came flooding back to me recently when I was asked to help a doctor on drafting a complaint response to a patient. The doctor felt very strongly that their treatment had been reasonable and wanted to (robustly) defend their position. Someone had suggested to the doctor they should apologise.

This was a difficult pill to swallow and the doctor and I had a discussion about how that proposed apology makes them feel (I can't repeat here the expletive used), what they are apologising for, what they think the patient wants an apology for (this was very unclear) and how this apology might help resolve the complaint. Importantly, we talked about what a sincere apology might, potentially, look like – especially in the context of a robust denial. This latter part was by far the trickiest.

Reluctance to say sorry

I find most people don't like to say sorry, even more so when they think they have done nothing wrong. Indeed, some people can never apologise even when they have done something wrong. So ... with all this reluctance and concern about such a small word, why is an apology such a big deal in the context of a patient complaint?

Benefit of saying sorry

When said properly, and with real planning and thought, a ‘sorry’ can really help diffuse tension and it can bring people together. Over my two decades of advising doctors, I have seen the effects of that small word. I have sat in some meetings where a doctor has cried to me about how sorry they are, how difficult it was for them to deal with this, but they felt they couldn’t say any of this to a patient … why?

Fear factor

You might not agree with the complaint but you can be sorry. You can be sorry you have let the patient down. That doesn’t mean you are admitting negligence or agreeing to pay them compensation. GMC/Nursing Midwifery Council and Care Quality Commission guidance makes it clear saying sorry is not tantamount to admitting liability.

Throughout the years in dealing with my cases, sometimes admissions of negligent treatment have been made but, even then, some doctors I have advised/represented worry about saying sorry for fear of regulatory referrals or other ramifications. There is often sometimes so much fear in making an apology that people shy away from it completely but let's turn the fear around into a positive, and powerful, experience.

Having represented many doctors before the GMC, my own experience is that a meaningful apology at the time of an incident can demonstrate real insight and genuine remorse/reflection, as opposed to making an apology when prompted to do so by lawyers. Indeed, the GMC's guidance supports an apology when you know something has gone wrong.

How to word it?

My advice is always to put yourself in the patient's shoes and really think how they are likely to be feeling at the time they made the complaint. What do you think they would like to hear sorry for and then really think about how you can tailor your apology to meet their needs/wishes:

– ‘Sorry we let you down in delaying this referral’

– ‘We are really sorry you have had cause to complain and sorry this has led to so much distress and worry for you’

– ‘I am sorry you are feeling let down by me, this was never my intention’

– ‘I am sorry you are so upset about all of this, I can understand why and I would really like to work together to resolve this’

These words can be extremely powerful. It connects with patients.

Sometimes patients ask for an apology but you may genuinely not know what the apology is for. If that happens, why not gently ask them to explain how an apology might look to them so you can really think about this.

When or how to do it?

These five letters can be extremely powerful at the start of a complaint. Think carefully how to apologise to this particular patient and do it with real meaning. How best to do that? Well, they say that face to face is the most powerful form of negotiation and I think that also comes through when having difficult conversation, too – so face to face is always a great start if you can. If you can't do that, then video, phone or email are the recommended modes of communication in that order. Written communication for sensitive matters should always be a last resort, although following up a meeting to confirm the apology (with the words you used) can be helpful.

If you do want to apologise, plan what you will apologise for and think about the tone and delivery of the apology. Be careful to make sure it is sincere and let the patient hear how sorry you are. Why not say it out loud and ask a colleague what they think. If you were listening to your apology as the patient, what might you be feeling?

Don't fear apologising. See it as a positive way of potentially resolving a complaint but only if it is done in the right way and with the right intention/wording.

As always, before providing any response (apology included) in any medico-legal complaint you should seek advice from your employer (if applicable) and indemnity provider/insurance company.

My own advice to you is to not shy away from say sorry – tackle it (even if it makes you feel uncomfortable) and see the benefits it may bring to your patient and to you, too. This is especially the case if saying sorry can resolve a complaint at the early stages and save the stress and time of further complaint correspondence and a potential claim.

Lisa Nabou is a consultant solicitor with BMA Law