Nobody's perfect. Everybody makes mistakes, it's only human. Medical errors, though, are different. They can be devastating for the patient -- and for you.

Dr. Michael Myers, a BC psychiatrist who specializes in physician health, has heard the desperate voices on the other end of a phone line from colleagues who believe they are culpable. The voices are often filled with fear and panic about a possible error -- and often also with abundant remorse. "These are very conscientious doctors," explains Dr. Myers, "the kind you'd want looking after you."

The cost of a mistake to one's sense of self can be dear. Shame, self-loathing, a loss of confidence can be professionally and sometimes even physically debilitating. Years of medical mentoring and training hammer in the importance of independence and self-reliance; bearing the full weight of an error can be crushing.

When an incident happens, it's essential to find someone who will listen. "Someone," says Dr. Myers, "who will allow you to express your feelings completely without jumping in prematurely with reassurances." He suggests talking to a psychiatrist in professional confidence.

Step back
Confronting the emotional aftermath begins with taking a step back to evaluate what has gone wrong. "There is often a difference between perceived error and actual error," explains Dr. Myers. He's quick to emphasize that responsibility seldom rests with one person alone.

The new disclosure guidelines for adverse events from the Canadian Institute of Patient Safety (cpsi/icsp) -- www.patientsafetyinstitute.ca -- support the doctor's opinion and caution patients against jumping to conclusions. It's worth a read if you find yourself in a situation where you think you may bear part of the blame. The guidelines read in part:

"A single failure rarely leads to harm. Most often a series of failures cascade to result in harm. While healthcare provider error may appear to be the most obvious contributing factor, latent conditions such as equipment and facilities design, training and maintenance, and organizational factors such as policies procedures and standard practices, usually contribute to the cause of the harm."

To acknowledge the likelihood of multiple contributors to an error is not to shirk your own responsibility. Raising the possibility of several causes often opens the door to a more clearheaded evaluation of what has happened. It's healthy to set aside the ideas of fault and blame. We live in an adversarial culture that sustains itself by locating the culpable party and exacting retribution and it helps to remember that real life is never quite so black and white. There is more recognition of this human reality than there has been. A public discourse about preventable errors now underway has rephrased medical mistakes as "adverse events," which casts a wider net of possible causes.

A physician's primary responsibility is to the patient who has suffered the harm. After taking wise counsel -- including a call to the Medical Protective Association should there be any question of legal action -- a timely, comprehensive disclosure is the best way to go in most cases. A patient needs to know what has happened, and will also expect to hear "sorry." Seize the opportunity. Disclosure, when done appropriately, can also be the purgative needed to restore one's self.

An apology is a powerful thing. Not the kind that we too often see, when the performance of the act, emptied of all sincerity, but broadcast for effect is meant to stand in for the regret allegedly felt. But the honest kind, where responsibility is accepted, and remorse and empathy are expressed. Apologizing should not be seen as admitting to liability. More and more legislators and medical institutions in North America are creating room for apologies, which can reduce the frequency and duration of malpractice suits.

How to say "I'm sorry"
That said, disclosure can be stressful and, if it goes badly, that stress is compounded and will only make the prospect of any future disclosure all the more traumatic.

Take steps to prepare. Consider what the patient must know. What are the facts surrounding the harm? What has been done and will be done to minimize the effects?

Also think about how this incident relates to the patient or the patient's family's confidence in you and the institution where you work. An error has happened; they may want to know what lessons can be learned from it.

Attending to these concerns during disclosure can help restore injured trust and open the opportunity to express regret. Forgiveness can be cathartic. Being frank and up front reveals a person's humanity and shows respect to those being offered that honest confidence.

Learning to be a skilled apologist is not something most of us aspire to, but good disclosure techniques do require practice. Rehearse what you plan to say with someone who you trust and who will give constructive feedback.

Above all, be prepared to forgive yourself. Be wary, says Dr. Myers, of the perceived scorn that colleagues may feel for you if you have been involved in an error or an adverse event. It's a projection, he insists. Don't keep the matter entirely to yourself, he advises. There are people who will lend a sympathetic ear. Talk about what's happened with others you trust. "There are lessons to be learned," says the psychiatrist, "they will make you a better doctor."