But there is one aspect of the duty where there is still some uncertainty and confusion: the apology.
Outside of the professional relationship we rarely give the social courtesy of an apology a second thought. An accidental stumble into a fellow passenger on the tube will normally elicit an apology from both parties. When comforting a friend who has bad news we will commonly say how sorry we are. We could hardly imagine walking in late to a meeting and not apologising.
So far, so simple. But where an apology is perceived as being difficult to give freely is when the words “fault” or “blame” crop up. On the one hand it can be easy – if I accidentally tread on a stranger’s foot it is plainly my fault and an apology is natural and instinctive. Yet consider the situation where an argument with a friend has ended with much upset because of the depth of feelings on both sides. You may feel you have done nothing wrong, so an apology may seem so much more difficult; the words might stick in one’s craw. But it is still the right thing to do, even if it is not an instinctive reaction, because it is a process of reconciliation.
Let’s look at a couple of clinical scenarios to illustrate the tensions sometimes encountered in making an apology.
A broken suture needle
A 40-year old woman attended her GP for excision of a lipoma on her back. The GP, who was skilled and experienced in minor surgery, excised the lipoma without difficulty. The cavity was sufficiently large to require a couple of deep, interrupted sutures to close it. Unfortunately, the curved needle snapped when placing the second suture and took five minutes to locate as it was deeply embedded in the deeper tissues which needed further dissection. The patient was anxious about the additional “digging about” to locate the broken needle.
Whilst an in-patient on a medical ward, a 56-year old man had some blood taken for tests. The phlebotomist put a small adhesive dressing over the puncture wound. The following day the patient had an intense, red, itchy rash where the adhesive dressing had been in contact with the skin. Having reviewed the rash, the patient’s consultant concluded that it was almost certainly an allergic reaction to the dressing adhesive. However, on reviewing the clinical records there was a clear reference to the patient having an allergy to a specific brand of adhesive dressing.