Why don't you apologise?

In the last episode, we talked about what happens when things go wrong,
and we left an important part of it, which is apologising.
Today, we will talk about how we do it, why, and how do we accept an apology.
It's Yuen.
And Mike. Welcome to The Imperfect Clinician.
How do we apologise? Euan, what is an apology?
I think apology is a way to express regret, whether it's via action or inaction,
something that we did or didn't do, or what we've said and acknowledged the hurt
that we inflicted on somebody, whether it's knowingly or unknowingly.
What do you think it is?
Apologies for me is an act of accepting responsibility or accountability or feelings
or emotions where you feel in a position that you are either representing either guilt
or some sort of misgivings that you were part of, or it was fully inflicted by you.
And I think that it has a function for both the person who is apologising
and for the person who is accepting the apology.
Yes, I think it's really important because it allows us to re-establish relationship,
or heal it in a way.
Yeah, and there are many levels of apologising.
I mean, first of all, do we actually mean it?
Do we mean, and how do we make sure that we mean the apology?
How do we make sure that it's received as a sincere act of admitting failure, in a way?
And you can apologise to patients.
The apologies can be casual or serious.
There can be apologies to the team or within the team, to relatives, friends,
and all of them can be, well, more formal, less formal.
There is a variety, an absolute plethora of ways of apologising.
But what is the function of it?
I think apologies strengthen our relationship, any relationship,
because it shows that I can reflect on my behaviours.
I am showing that I'm listening to your feelings,
and I'm trying my best to make things right by giving you the space
to talk about your feelings and acknowledging my responsibility in it.
Yeah, and that's how I would see it as a re-establishing or maintaining
or growing the relationship.
I think the growing of the relationship is further down.
And when we are apologising to people we're not particularly attached to,
it takes on the function of expressing regret.
And we do it to heal this relationship, however long it might be,
because it might be we're apologising to somebody who we know for many years within the family.
But also if it's within the patient, we want to reconnect
and also show our point of view on the case, yeah.
Yeah, and I think it's important never to ruin an apology with an excuse.
That's a quote from Benjamin Franklin.
What do you think are other ways to ruin an apology?
You can ruin an apology in the way of, for example, picking the wrong timing.
You can apologise too early, you can apologise too late,
and also you can apologise by not being sincere.
Do you want to build on it?
I, for me, I get really defensive when I hear but in the apology.
I'm sorry but, because it feels like you're building a defence for yourself
and you're not fully accepting, or if I hear an if in the apology.
I'm sorry if.
Again, same thing, don't feel like the person who's apologising
is taking on full responsibility of their mistake.
So I feel like apologies should be like, unreserved.
Yes.
And I think another way of ruining an apology is to request for an apology.
I think that's forcing people to do things that are not intended.
And they're not ready.
So they're not ready yet.
I think the apology need time and space.
And I, for me as a person, I always tend to process the situation.
Then I apologise after.
But it's like with very often there is an expectation of apology.
I don't know, with the children doing something
and they cannot fully understand very often what they've done wrong.
So making them apologise, it's not going to teach them about the situation.
Yeah.
It's just going to force them to express something that they're not sure.
And it becomes then automatic and not very sincere, not very honest.
I agree.
And I think apology shouldn't be a given for me.
So I struggle to apologise on the spot when emotions are still running high.
Because I know when I speak, I would rather retreat and gather my thoughts
rather than inflicting more hurt verbally.
And when you said about forcing an apology, it's not heartfelt,
but also more importantly, the action doesn't change.
If you're only saying, I'm sorry, just because,
then you wouldn't really have the opportunity or the chance to learn from the mistake.
Okay, so apology should come with an action plan.
That it's something going to prevent us from repeating the same thing in the future.
Yeah.
Essentially.
Yeah.
Well, I can apologise fairly quickly.
I think that it doesn't make it less sincere.
If you truly realise and you provide some extra reassurance at the time,
then I think it can be sincere if you give it straight away.
And sometimes you reflect very quickly.
It doesn't mean that you have the answers on how to change things for the future,
but you can reflect quite quickly because you may not be
acutely aware of things that you've done wrong sometimes.
I think that's how it's different for the both of us.
For me, apology is more, I don't want to say precious, but carries more weight.
When it comes with it, this is how I know I've done wrong.
I'm going to do it differently this time by, and then you talk about it.
And so when I...
Yeah, but does it make it less more sincere in the eyes of a recipient?
Yes, exactly.
So in my eyes, if you are apologising to me, for example,
I think the action plan is important.
Or as for you, apologising on the spot perhaps is more important than the action plan.
It's part of the action plan, apologising.
I think what matters is how you feel during this apology and how do you make it a...
Because you can feel whether something is sincere or not.
I mean, in most cases, you are able to say whether people mean it,
because it comes with all the other...
If you are unreservedly sorry,
and you do it in a way that you would like to be apologised to,
then I think it's very hard to be dishonest about it.
Yeah, I agree.
So now, what are the obstacles to apologising?
Why people don't want to apologise?
Maybe at first as well.
What's stopping you or others from apologising full stop?
The first one I can think of is anger.
When I'm angry, the last thing I want to do is say I'm sorry.
I want to end with anger.
It comes other parts.
It can be a combination of anger, pride and judgement.
So why should I apologise?
Now I sound like a six-year-old.
She did that first.
Or why should I apologise?
They've never apologised for their action.
Why should I do it?
Is it also fear of accepting responsibility?
Yes, definitely, because I think when you apologise, there is a power shift.
You hand over the power to somebody else, and by doing that, you get quite vulnerable.
So perhaps the fear of being vulnerable as well,
that can be one of the obstacles for apologising.
What are yours?
I think that judgement is quite an important part of it.
I think also that lack of empathy is an obstacle to apologising.
So if you can't feel, you're not going to be prepared or ready to apologise in that way.
I think that it's very difficult to develop a skill of conscious apologising,
of being really in tune with how you can make people feel when you apologise.
Of course, it shouldn't be acting, you know what I mean?
I have a feeling that for us mere mortals, we are not trained to apologise,
but we can do it in a more conscious way.
We can reflect on things.
At least we can force ourselves when we see somebody upset by us or what we've done
or what our team has done, for example.
I think we can reflect on it and apologise not because it's the right thing to do,
but because we feel like we need to put this episode behind us,
because we want to express regret that something should have happened in a different way
or shouldn't have happened at all.
I think it is our job to apologise, whether it is our job to apologise,
or it's like a professional internal need to make things right,
the outcome of it should be honest and engaging.
I think expressing regret is a skill and we can be better at it.
People will cut through the, you know, insincere the emotions.
Yeah.
And I think it's also important to let others know that we are accepting responsibility
for what could have been done better or could have been done
or shouldn't have happened, for example.
I think it's also an opportunity to show the plan or to reflect on the plan
and the changes that we might do in order to prevent things happening in the future.
So would you say if I summarise it to regret, because you mentioned regret,
so you are expressing it in a genuine way and then you react and the reacting part
is about showing change, so planning change and following through,
so you can show that the changes that you've promised, you are actually doing it.
That you've seen it through, yeah.
And don't delay.
So you are doing it straight away.
And I would just add in, don't expect a return apology,
because there is this quote from Marion Klein that says,
an apology is a statement of regret.
As important as that is, apologising differs from asking for forgiveness.
That's a quote from Marion Klein.
So when I am apologising and sometimes when I receive an apology from somebody,
I see that this comes in a full sentence.
I'm really sorry, will you forgive me?
And I think then will you forgive me should be kept until the other person is ready too.
Because there might be some peer pressure to say that you forgive that person
when you are not fully ready yet.
Have you had that experience before?
Yeah, I mean, you feel often that after something unfortunate happens,
or you do something, if something happens that it's not entirely your fault,
I think it's easier to apologise than.
But it doesn't really have the same weight as if you were a person responsible for it.
And yes, there is a pressure to apologise because you know,
you bump into somebody in the street.
It's a social, I don't know, routine to apologise.
Whether it's your fault or not, people do that.
I noticed that it's quite prominent here in the UK.
Even if, you know, somebody steps on your foot, you automatically apologise.
So it's sort of expected from you to be partly involved in causing the problem,
even if it wasn't yours very often.
And I think that when you apologise, it's about changing things in the future.
It's about making an effort, a conscious effort,
to put that action plan in place and to apologise.
What do you feel, how does apologising can make you feel?
Besides being vulnerable, I feel sometimes it makes me feel relief
because I can put it out there and perhaps I feel better for doing it.
Okay.
Yeah, if it's honest, I completely agree, that's absolutely fine.
But are you apologising because it makes you feel better
or because it will make the other person feel better?
What's the motivation?
I think this is something that we can, when we're talking about conscious apologising,
that's something that we need to answer ourselves.
I want to say there are situations where either or of these apply.
So I would sometimes apologise because if I don't, I feel guilty.
Or sometimes I don't feel like apologising, but it will make you feel better.
And how do we differ our apologies depending on who we're apologising to?
Is it also a difference or the sincerity should be the same?
Or how do you grade it?
I feel sincerity if you apologise to make the other person feel better.
I assume it wouldn't be as sincere compared to if you're actually apologising
in your own terms or in your own time when you're ready.
What we're going to do, we're going to...
Role play.
Role play.
Okay, everybody loves a bit of role play.
Especially as clinicians.
Especially as clinicians, we've done many of those.
Okay, so we want to discuss now about accepting the apology,
because we've been discussing how does apologising make us feel?
And now how do we accept the apology?
I think it's a very important part of the whole process.
So, okay, let's start it.
Ewan, I'm really sorry, but I broke your favourite plate.
It's okay.
So how many of us, when we hear I'm sorry, we say it's okay?
Just reactively.
Yeah, how does it sound?
Because it took me some level of bravery to say sorry for doing something disappointing.
I mean, you need some courage to go back to the person,
whether it's the most minor or some more major problem that's happened.
But it does take courage.
You make an conscious effort.
You make an effort to apologise for it, if you really mean it.
So when you say it's okay, it just sounds like you're shutting it down.
Sounds like you don't really care about the process of admitting the failure,
of admitting and, you know, apologising, expressing regret.
So now can we do it better?
Should we try and do it again?
Of course.
Okay, so Ewan, I'm really sorry, but I broke your favourite plate.
Thank you for the apology.
I needed to hear that.
That really hurt me.
So I feel this appreciates the effort and it treats you,
the person who's providing the apology, seriously.
And allows me the space for pain and perhaps sharing the pain between both parties.
Yeah, it can be painful to apologise.
And, you know, we're not talking about very trivial things very often,
especially when we're talking about working with others or within a family.
And it takes courage, it takes commitment and it takes a bit of reflection
to be brave enough to hide your pride
or whatever the obstacles you might have to go over to say sorry.
And when you say it's okay, you're minimising the hurt that you are feeling.
And like you've mentioned earlier, I'm dismissing the courage from you.
So we have been trying every single day by practice,
trial and error, to say, instead of saying it's okay,
we've been trying to say thank you for the apology instead.
And I know a lot of people actually struggle with that.
So try doing it in the next two weeks and see how you react to an apology.
Oh, how do people react when you say thank you when they apologise to you?
Oh, definitely, yes.
I think it's a good exercise because you'll be surprised
how different people might approach your statement.
I mean, it takes a lot of courage often to apologise,
because you are owning up to your mistake
and your share in the situation or the argument.
And now you have a situation where you say thank you
and people look at you differently.
Yes, because by saying thank you for the apology,
I accept how hard it is for you or a child or a colleague to say sorry.
And I accept that you take responsibility for your action
and you are apologising for your wrongdoings.
Okay, so apology can be hard, I agree.
But can it be seen as a weakness?
Yes, it can be seen as a defeat.
For me, sometimes.
Because I feel like apology is…
I'm talking about this less trivial and a little bit more serious
as an act of courage,
because we don't want to admit it in a lot of cases doing something wrong.
And I think it takes some…
You have to commit yourself and you have to actually make yourself words
that sometimes may not be easy to go through,
because you sometimes don't see a problem
as big enough to justify it with an apology.
I heard a quote that affected me deeply when you've mentioned that.
There is this quote by Harriet Lerner, she said,
the capacity to offer a meaningful apology
rests on how much self-love and self-respect that person has available.
And it perhaps also explains why I find it harder to apologise compared to you.
Well, yeah, there is that.
Okay, so let's have a little think about…
Because I mentioned before about the timing of the apology.
Is there anything too late for an apology?
I want to say no.
Does the timing matter in that case then?
I don't think so, because I still stand by…
I think we should give people time and space to apologise
and they shouldn't do it until they're ready.
And even if it comes much later, I would still be happy to get that
compared to either getting it too early when they're not ready or none at all.
Do you think that apology that's been put together or reflected on
is more precious because of time?
Yes.
Well, I don't think it's because of time.
I think it's about the sincerity of it, rather than time itself.
I see time as something that provides different function.
So time in this case, perhaps, like I mentioned earlier on about self-love and self-respect,
maybe they haven't been able to have the courage to accept their part in it,
hence not being able to.
But when they do, the sincerity will be more when they're apologising.
Okay.
So how about let's flip it the other way around and talk about apologising in advance.
What do you mean?
Okay, so because very often we apologise before we know that something's going to happen
that may not be received very well or something you might do,
something that you assume is going to be badly intended.
So we want to secure yourself in a way.
But what's the purpose then?
We might as well not do it.
Yeah, but does it mean that you already sort of reflected on a hurt that might be caused
or you're assuming that it can cause pain and should you proceed?
I think perhaps you're saying that so you are in some way trying to cushion the blow
because you know it's going to hurt.
That's why you said sorry before.
That's very true.
But is it a matter of being obnoxious that you know you're going to hurt someone
and you're apologising for it already?
It depends on the context.
That's what I mean.
So I think because sometimes it can be like just sorry, not sorry.
You know, it depends on the context.
So should a comedian apologise for offending beforehand?
You know, the context is the comedy show.
Okay, so that's one thing.
But in a clinical setting, I am sorry for what I have to tell you might be read unintentionally.
Or is it acceptable?
I want to say yes.
And I know some clinicians apologise before the bad news and do it after.
How do you feel?
Because you have to tell something to the patient that they're not going to like
because of the diagnosis, because of the outcome of the examination.
I have tried both.
I personally prefer to apologise after I presented the facts and explain
after the patient accepted what I've said and listened.
Because I found sometimes when I say at the start, it sends patients into panic mode.
Yeah, I think that it does put them into panic as well.
And it increases the anxiety because they already come into you anxious about what's going to happen.
And you just starting with the reservations.
We are starting with something that's going to start like a difference of power in the discussion.
And I think that then loses its ability to be the apologies,
lose the ability as a function of empathy and understanding.
And I think for me, it's also easier to get down with the facts first, then apologise later.
It's not entirely apologies for what you've done or what you haven't done.
It's just empathy as a professional passing on the bad news.
Yeah.
And I guess as clinicians who are listening, we will be curious on how you do it.
Do you do apologies first, apology first or after?
And if you're not a clinician listening, how would you prefer to receive the news?
Let us know in the comments.
That's a very fair point.
We hope to learn something from this as well, because it's good to be on there.
I mean, we are also patients and we also have an idea of it,
but I have a feeling that we have more understanding or more immunity to the bad news.
And because we hear, you know, you don't come to the pharmacy,
you don't come to the doctor when everything is super fine.
You come to us when there is a need for it.
It's not a, you know, sweet shop where you go when you feel great or...
Or travel agency.
Or travel agency where you want to go on holiday.
Yeah.
So yeah, but there is one more aspect of that.
How do we respond when somebody comes to you to have a conversation with you
and they tell you, I'm sorry, I'm a bit not well, but my husband passed away.
Should you apologize?
Because we often do say, oh, I'm sorry to hear that.
I'm sorry to hear your husband passed away.
I'm sorry to hear about your diagnosis.
I would say that.
Would you say that?
Or I would say, I'm sorry to hear that.
How are you?
Just to see how people are feeling.
I usually, I don't know, from the personal empathy point of view,
I say it must be very hard for you because I don't want to dismiss anybody by saying,
I know how you feel.
Because we don't.
We don't.
I think this is a wider discussion about empathy.
And I think that in this context, apologizing for that is not really what people are coming for.
They're coming to have a listening ear usually.
And just to present us with the situation as an explanation of why they are shaken,
why they are anxious, why they are not themselves.
And I think that everyone's pain is different.
And I don't want to tell the patients that I know how they feel.
I know what they're going through.
Because if you're experiencing pain, this is the worst thing that can happen to you.
And no one else can fully get it.
And I think that it is quite heartbreaking for us.
Because we would like to say, right, yeah, I've lost my parent.
But I think I should refrain from it.
Because then it puts me in a position of, right, I know better.
And I don't want to take this recovery process from the patient.
I don't want to all of a sudden share the pains, oh, we're all miserable here.
I think it's important to give them the space
to sit in with their pain and acknowledge their pain and say that I'm here to hear it.
And I'm here whether as a clinician or whether as a friend or as a family member,
I'm holding this space for you.
So you can be or cry or do whatever that you need because I am here.
Very true, very true.
So something a bit the other way, we're talking about apologising in advance.
How about the socially beneficial apologising?
What do you mean by that?
Okay, so you're apologising for not turning up.
I think you should do it.
I think we're quite clear here.
I'm sorry I'm not going to be there.
Yeah, definitely.
Because people might be waiting for you.
I think this is just rude.
That's the socially beneficial, we would say, way of apologising in advance.
Definitely.
Definitely, yeah.
But as I say, we're all clinicians approaching things in a different way.
We come from different backgrounds, we have different experience.
And I'm not quite sure whether it sort of applies, whether you ever consider that.
But when you're talking to a clinician, do you think it's a difference between
hearing an apology from a young doctor and a more experienced doctor?
Don't think so.
Don't think so.
It shouldn't do.
Well, I think it shouldn't do, but I think it can do.
I think it depends on the individual, maybe.
I think it's biases then.
Then we're erring into the areas of biases, which is going to open up a lot more conversation.
That's very true.
That's very true.
No, we don't want to go just to the, you know, experienced clinicians.
Okay.
So now, what are your thoughts on apologising when you have no contact or when the person
refuses to be in touch?
I have somebody like this, but in this case, I apologise to make myself feel better
because I know if the other person is not ready to hear from me, I will inflict more
harm if I try to get in touch.
This is what I'm thinking.
I might be wrong.
Okay.
Is it self-care?
Self-care in what way?
In terms of to make myself feel better?
I wouldn't call it self-care, but yes, I did it to make myself feel better.
I feel that I need to release the burden.
Yeah.
Do you think you should like close the chapter or let it go?
It was closing the chapter.
So I wrote a letter and I didn't send it off.
I didn't know where to send it to, but when I wrote the letter, it felt very cathartic
for me.
So it felt like I was able to address the hurt, address the hurt that I've inflicted,
perhaps address some of the hurt that the other person has felt and explain on the why.
And then I just released it in the ether.
That's an interesting way.
I don't think I would have thought about it that way.
I think it was sitting on me for way too long and I was struggling to find ways to
lighten the burden.
And the only way that I could think of in the first way I thought was this and actually
make me feel better.
So it helped.
I wonder what's your thoughts on if the person that is or was inflicting hurt or trauma on
you, is it fair for you to expect an apology from that person?
Depends on the context, but I think it's fair to expect an apology, but I wouldn't look
out for it.
Generally, I wouldn't want to force an apology because I knew that it would have been sincere.
But it would be nice for people to acknowledge because apologizing is also a form of acknowledgement
that something you've been doing was wrong.
Did you say you wouldn't expect it because it would be insincere?
I wouldn't force an apology.
No, I would say that it's okay to expect an apology in yourself for someone that's doing
something towards you, like certain things that, for example, my dad did.
I would expect, but I would never force an apology because I knew it would not be understood.
To apologize, you need to understand what was hurtful and that would have been difficult.
How about you?
I think no.
I think no in different reasons.
I think because my recovery should not be reliant on the apology of the involved party.
Oh, this is what I said.
I wouldn't force this apology because I'd rather have no apology than insincere apology
because then it would have been conditions.
I'm sorry that I affected you, but or if I offended you, because if you say, I'm sorry
if I offended you, that doesn't, you don't feel that you have offended anyone because
you're just blaming the person's reaction.
Yeah, correct.
You're blaming the person who is supposed to accept your apology for demanding it.
And I think one of the biggest touching stories that I've heard by Sarah Montana, who was
one of the speakers for TEDx, she shared a tragic experience of losing her family to
gun violence and the trigger was pulled by her brother's friends and her exact words
were forgiveness is designed to set you free.
When you say, I forgive you, what you are saying is I know what you did is not okay,
but I recognize that you are more than that.
I don't want to hold us captive to this, to this thing anymore.
I can heal myself and I don't need anything from you.
And I think listening to her really helped me find the ability to heal because I let
go of the notion that things in the past can be changed.
And I accept that the hurt that was done, even though painful was done with the best
of intention and by realizing that I was able to let some parts of the trauma go.
So forgive or forget, will you forget if you can't forgive?
You have to close the chapter then.
Yes, I think closing the chapter and accepting that as part of me and removing the blame
because I think the blame is the anger and perhaps a level of powerlessness still
shouting and screaming.
And in some ways, if I surrender to the past, because I can't do anything about it,
I am able to let go, let go of the negative emotion that is like a vicious circle.
Hmm.
But forgiveness is harder than apologizing.
I agree.
I wouldn't agree in terms of the over it.
I would say you must have dealt with it.
That's what I mean.
I mean, not completely over.
Obviously there are some things that are inexcusable and maybe lifelong memories.
But I'm talking about you sort of dealt with it and decided to let go.
Emotions, deal with the emotions of yourself, perhaps deal with some emotions that potentially
might be from the other party who's inflicted that on you and not a overnight process.
It's a, for me, it's a continuous nights of journaling and meditating and other bits before
I can get to that point.
But yeah, I agree.
Forgiveness is much harder than apologizing.
So now have you got anybody you need to apologize to?
Have you got anybody that you would like to get apologies from?
Have you forgotten anyone?
Have you for forgiven anyone?
Are you still waiting to forgive or have you been forgiven?
Have a little think and reflect.
And remember that practice.
Thank you for the apology.
See how you get on.
See how we get on.
Thank you for today.
It's about time for Yuen Reads.
Welcome to Yuen Reads today.
I'll share a book that I took with me every week to work until I slowly got the message.
So this book is called The Advice Trap.
Be humble, stay curious and change the way you lead forever by Michael Stanier.
I guess in the healthcare industry or any work that you do when you're more experienced,
it's very easy for you to just say, oh, I know the answer.
Let me tell you.
And I guess I fall into the advice trap of giving advice without actually realizing what's the problem.
And in the book, they call it the advice monster.
And I think my advice monster is really strong.
Trying to use a gaming analogy.
I'm fighting the advice monster with all the equipment and guns and everything that I've got.
It has got really useful step-by-step instructions.
For example, the kickstart question, what's on your mind?
What else?
So essentially what it has taught me is before anything else.
So when somebody asks me a question before rushing to answer, because I'm trying to prove myself
that I know it and I need validation or for whichever reason,
or I want the problem to be solved quicker.
I need to see all of these as an opportunity for the other person to grow.
And so I need to find out more about the problem.
And by asking the set of questions that have been provided in this book,
it allows the other person to reflect because you don't know the full extent of the problem.
You're not actually in it.
The other person is.
And so hopefully with guided questions, you can in some way coach the person to come to
the conclusion themselves.
I think that pause is the hardest to cultivate or I guess hardest to practice
because my reaction time is seconds, many seconds.
And the pause requires me to take a deep breath, drink some water,
and then almost reset my brain and say, tell me more.
Hopefully my team have noticed I've made an extra effort.
If not, please do tell me and I will bring this book back again with me to practice.
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Bye for now and until next time.