Basketball fans are undoubtedly aware of an incident that took place during March Madness this year. It went like this.

March Madness Goes Wrong

Gonzaga was playing Northwestern. Gonzaga was up by 5 points with 4:54 minutes remaining in the game when the Northwestern Wildcats’ Dererk Pardon attempted to put the ball through the net. At this moment, a player from the opposing team stuck his arm through the rim and prevented the ball from entering the basket. This is called goaltending and should have been two points for Northwestern, making it only a 3-point game. Instead, Gonzaga got the ball and rushed to the other end of the court to score. A technical foul was called on the Northwestern coach, Chris Collins, for his vociferous objection to the non-call. This resulted in a 5-point swing in the score and may have determined the outcome.

After the game, the National Collegiate Athletic Association (NCAA) acknowledged the error. However, to the best of my knowledge, the referee didn’t apologize.

What It Means to Say You’re Sorry

This whole incident made me reflect on what it means to apologize. In life and medicine, sometimes saying you’re sorry is just the right thing to do.

In an interview on NPR’s “Talk of the Nation,” Dr. Manoj Jain describes a medical error he once made and explains why he felt an apology was warranted. Dr. Jain unwittingly gave an antibiotic, forgetting the patient was allergic to the medicine. That led to an allergic reaction. The patient recovered, fortunately, and Dr. Jain apologized. The patient accepted the doctor’s apology, but Dr. Jain remembers feeling guilty and embarrassed.

Physicians fear that an apology is admission of guilt with liability implications. A PainExperience article points out, “our malpractice insurers tell us that an apology might be interpreted as an admission of fault or negligence that could expose us to litigation. There are even some insurers that will void our malpractice policy if a doctor apologizes to a patient in the wake of a complication or error.” In fact, the article covers the “benefits of offering an apology when things go awry and the techniques of apologizing without admitting guilt.”

Doctors Are Human, Too

Medical professionals are not infallible, although patients want us to be. When we make an error, patients are often angry and want to understand how the mistake happened. They deserve an honest explanation, regardless of the consequences to the physician and liability company. Moreover, doctors can find their patients’ forgiveness beneficial and even necessary.

Doctor/patient relationships require trust and honesty. That means doctors have to be willing to admit making mistakes. Of course, it requires courage to admit being wrong. It’s most difficult when the mistake is egregious or leads to death. But, even when the consequences are less dire, it’s still hard to say that you’ve made a mistake. You never know how patients and their family members will react.

The doctor’s response to making an error exposes his or her character and people’s perception of the doctor’s competence. Also, a doctor who admits culpability must leave the question of forgiveness to the patient. In a sense, the doctor concedes the power to the patient, and that can be difficult.

Saying You’re Sorry Can Lower Costs

Ironically, admitting culpability can even lower liability costs. According to a New York Times article, “Since 2001, the University of Michigan Health System has handled patient injuries by initiating discussions with patients and families, conducting internal investigations and offering apologies with offers of compensation should those investigations reveal medical errors. To examine the repercussions of such an open disclosure with compensation policy, researchers analyzed the number of claims and lawsuits filed against the hospital system between 1995 and 2007, comparing data from before and after the policy took effect.” Naysayers might have expected such behavior to increase costs. However, “the researchers found that there were actually fewer lawsuits and claims after the hospital began its disclosure with compensation program. Moreover, the hospital system’s liability costs for lawsuits, patient compensation and legal fees dropped, and claims in general were resolved faster than ever before.”

An Apology Can Be an Offering of Compassion and Caring

Monetary considerations aside, sometimes, saying “I’m sorry” is simply an offering of compassion and caring. It’s not necessarily a statement of wrongdoing…and it can be such a healing gesture for physicians and families.

Let’s get back to the basketball game. It is not clear why the referee did not apologize for his blatant non-call during that March Madness game. However, I am sure he feels the same shame and embarrassment that physicians experience when they know they’ve made a mistake. Perhaps the NCAA, too, has a policy in place that prevents their referees from saying “I’m sorry.” If that’s the case, then maybe the NCAA should reevaluate its policy just as medical liability companies have done. Until then, the Northwestern players and fans may be waiting for their apology.