An apology after medical harm still matters, but perhaps not for the reasons medicine once believed.
For a long time, medicine saw apologizing after a bad outcome as risky or, at best, a way to protect oneself. Doctors were told to say as little as possible: Avoid guessing, don’t admit fault, and don’t apologize. This made sense in a legal system where lawsuits are common. But after a serious mistake, staying silent rarely feels neutral. It can seem like abandonment. Using vague language can make people trust you less. Families who already feel hurt may see this caution as a lack of caring.
The push for more open apology came as a needed change. This approach, unlike old practices of silence, suggested that patients and families are less likely to take things further when doctors are honest, caring and take responsibility. People may sue not just because they are upset over what happened, but because they feel ignored or lied to. A genuine apology, along with an explanation, can help ease anger, preserve trust and perhaps even reduce the risk of lawsuits.
This openness helped medicine improve. However, new research urges us to reconsider the connection between apologies and legal risk. The issue isn’t the value of apologies, but whether apologizing alone truly reduces legal risk. The relationship is more complicated than once believed.
Many states have passed apology laws to help doctors express sympathy or regret after something goes wrong. The idea was obvious: If doctors could say “I’m sorry” without worrying that it would be used against them in court, communication would improve and lawsuits might go down. According to the National Conference of State Legislatures, 39 states, the District of Columbia and Guam have rules on medical apologies or sympathetic gestures.
But research has complicated this idea. For instance, in the 2019 Stanford Law Review article “Sorry Is Never Enough,” the authors examined malpractice claims and found that apology laws did not achieve their goal of reducing legal risk. In fact, for non-surgeon doctors, these laws led to more lawsuits and higher average payments. The authors suggest this occurs because, when patients are unsure whether a mistake occurred, an apology can provide new information that prompts them to file a claim.
The uncertainty continues with newer studies. For example, a 2025 study in the Journal of Medical Internet Research titled “On the Influence of Apologies on the Likelihood of Lawsuits” examined how apologies affect the decision to sue. The results showed that physical and emotional harm were strong reasons people considered suing, but whether or not an apology was given made little difference. The authors concluded that written apologies alone had little effect on lawsuit decisions and that reducing risk may require more than just saying sorry.
It’s important to interpret these results carefully. They certainly don’t mean that apologies lack value. These studies instead highlight that an apology alone cannot undo harm or guarantee legal protection.
Moreover, most patients want more than just an apology. In a national survey conducted in 2024, 78 percent reported wanting an explanation and assurance that steps were being taken to prevent future harm. Beyond an apology, they want to understand what happened, know that someone noticed the damage, find out if the event will be investigated and learn whether it could happen again.
Because of this need for more comprehensive communication, today’s best approach is called communication and resolution. The Agency for Healthcare Research and Quality (AHRQ) Communication and Optimal Resolution (CANDOR) process helps health care teams respond in a timely, thorough, and fair way when something goes wrong. The process includes being open about what happened, analyzing the event, supporting caregivers, learning as an organization, and finding solutions. Apology is just one part of this bigger system, not something to do on its own.
The latest research supports this approach. For example, a 2026 review in the Journal of Patient Safety and Risk Management found that communication-and-resolution programs reduced the number of claims and legal costs, though the evidence was limited. Specifically, resolution times, lawsuit rates, costs, and settlement amounts either decreased or remained unchanged. However, the review found limited evidence of any effect on patients, families, staff, or overall quality and safety.
This distinction is vital. While full programs can help with legal results, that’s not the same as saying that simply apologizing will stop lawsuits. A 2025 study from Tennessee in the same journal found that after a hospital started a communication and resolution program, defense costs dropped by 58 percent and claims dropped by 42 percent compared to the rest of the state.
Still, this doesn’t mean doctors should try to make legal judgments at the bedside. Not every bad outcome is someone’s fault. Medicine always has some uncertainty, risks, and complications, even when care is good. Doctors shouldn’t guess or blame anyone before knowing the facts. But we shouldn’t stay silent either. Patients deserve kindness even before an investigation is finished. They deserve to hear what we know and to see that we are open about what we’re still figuring out.
Therefore, the main takeaway from recent research isn’t that apologies don’t matter. It’s possible we misunderstood their purpose. Apologizing isn’t just a way to avoid lawsuits. It’s an ethical act that is part of a bigger responsibility to be open, investigate, learn, and make things right.
Doctors should still apologize when it is the right thing to do. Patients deserve to be treated as people, not just as possible plaintiffs. They also deserve more than just an apology. They need clear explanations, ongoing follow-up, visible accountability, robust prevention efforts, and a fair solution if poor care causes harm. Clinicians can best serve patients by applying comprehensive communication and resolution techniques rather than relying solely on apologies.
If liability risk decreases, it will not be because we discovered the perfect phrase. It will be because patients and families experienced a health care system willing to tell the truth, learn from harm, and make things right.
Timothy Lesaca is a psychiatrist in private practice at New Directions Mental Health in Pittsburgh, Pennsylvania, with more than forty years of experience treating children, adolescents, and adults across outpatient, inpatient, and community mental health settings. He has published in peer-reviewed and professional venues including the Patient Experience Journal, Psychiatric Times, the Allegheny County Medical Society Bulletin, and other clinical journals, with work addressing topics such as open-access scheduling, Landau-Kleffner syndrome, physician suicide, and the dynamics of contemporary medical practice. His recent writing examines issues of identity, ethical complexity, and patient–clinician relationships in modern health care. Additional information about his clinical practice and professional work is available on his website, timothylesacamd.com. His professional profile also appears on his ResearchGate profile, where further publications and details may be found.
