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A Non-Apology

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Life is not short of apologies. Whether it’s being late for work, accidentally knocking into someone, or speaking out of turn on a virtual call, everyone says “sorry” relatively often. It’s almost a reflex action.

There are lots of different way of saying sorry, though.

I’m sorry

How difficult, thank you for sharing that with me

I’m sorry it wasn’t great; but you’ve got to understand

I’m sorry you feel that way

In an apology, there is often an implicit requirement to differentiate between sympathy and empathy. There are many definitions, but I like this from the six seconds website.

Empathy means experiencing someone else’s feelings. It comes from the German Einfühlung, or ‘feeling into’. It requires an emotional component of really feeling what the other person is feeling. Sympathy, on the other hand, means understanding someone else’s suffering.

Empathy can be a challenge as it requires you to know that feeling. This may be difficult due to the memory of the event producing that feeling or that fact you have never actually experienced. The empathetic element of an apology is important because not only does saying sorry require a delivery but it also is generally predicated on acceptance. Apologies are generally well received in daily life, but it’s not always a certainty.

Brene Brown recognised that the response (i.e. the apology itself) rarely makes things better; the connection between the persons involved is needed.

In late 2022 Jeremy Clarkson issued an apology for a newspaper article he had written about Meghan Markle.

For some, this was the classic non-apology – “I will apologise for the hurt caused but not the initial transgression.”

The non-apology is a consistent discussion point on social media. Most people will have experienced non-apology at work and perhaps, if they are honest, will have given one. It is easy to get angry about it. “How dare people continue to forget basic empathy! What is the world coming to….”

I’ve no wish to defend Jeremy Clarkson. Regardless of any point he was trying to make; his words were clumsy and divisive. You don’t write a regular column without considering the impact your article could have. However, I do wish to defend, in part, the non-apology. In the past, I would have been shocked at myself for even considering such an idea. However, as a Head of Service of a large Children’s Emergency Department, it is becoming increasingly difficult to protect my staff from the moral injury that arises from having to apologise for things which they simply shouldn’t have to do.

This winter in the United Kingdom has been one the most difficult on record. A combination of high attendance, media scares, low staffing levels and general fatigue have pushed acute and emergency care to the brink. Health services tend to stay intact, but they can be pushed to provide consistently sub-optimal care. Derogation of standards such as waiting times are very difficult to reverse over time, and there becomes almost an acceptance of the status quo. The public has every right to challenge this, and so they should.

For those families for who the healthcare system has failed, no apology can ever make up for what has happened. Everyone, family and professional, will forever have that despair with them, knowing that something else could and should, have been done. Unfortunately, there are many complaints we don’t receive that we should.

What is more difficult for staff to deal with is the use of difficult situations to complain about a perceived inadequacy of service.

Dear Emergency Department

My daughter took my grandchild to your department last week. I was disgusted by the care they received. On arrival they were seen by a nurse who did some observations and told the family they were not concerning. How could they be not concerning? My grandson has had a fever for 2 days. This isn’t right.

They then waited 3 hours in the waiting room to be seen by a doctor. While waiting, every so often a nurse came and woke my grandson up to check his temperature. He was trying to sleep. Do your staff have no compassion? When finally the doctor came they said there was nothing to worry about. It was just a virus. We weren’t even given antibiotics.

On the information leaflet it said things would get better over the next couple of days. Well I had to take my grandson back to our GP today as he still has a cough. He hasn’t had a fever and the GP didn’t think anything else was needed. Imagine what would have happened if I hadn’t had pushed my daughter into taking him back to his GP.

Please tell me you don’t treat all your patients like this!

[this is a fictious complaint letter]

There is a growing trend of dissatisfaction with services which have been delivered in the best possible way given current circumstances. Staff cannot simply concede that more could have been done when it wasn’t possible, or wasn’t needed. Using terms as “I’m sorry you feel that way” may grate but does sum up what is needed. How we frame a response to vexatious complaints is an art. There must be some sympathy to what drives a person to take the time to provide feedback, but it will be difficult for many to empathise with. This further drives the problem, as a connection is never made with the underlying grievance. It will be difficult to ever do so; a face- to-face meeting just isn’t possible given the volume of work that needs to be done (although a phone call is sometimes remarkably powerful and often better received than a letter).

As services continue to struggle to meet an unrelenting need, we will have to have more open conversations about what standards of care can and needs to be.

I don’t want to merely sympathise with patients and families. But, perhaps, they will need to honestly emphasise with the limits of the healthcare system for it to truly empathise with them.

About the authors

  • Damian Roland is a Paediatric Emergency Medicine and Honorary Associate Professor. His research interests include scoring systems in emergency and acute care and educational evaluation. Damian also chairs PERUKI (Paediatric Emergency Research United Kingdom and Ireland), which gives him and the team an opportunity to raise awareness of the important of research and evidence based practice at scale. The list of the many things Damian hasn’t done or achieved is far longer but through these he learns and develops new ideas.

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