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Natalie Yeoman is mystified by the failure of a senior Southern District Health Board radiologist to apologise to her.
The DHB unreservedly apologised to Yeoman for radiologists working in BreastScreen Health Care reporting her routine mammograms in 2010 and 2012 as showing no evidence of cancer.
By the time the cancer was diagnosed, at a routine scan in 2015, it had spread to a bone in her head, affecting her hearing.
ACC accepted her treatment injury claim, finding that she could have been recalled after her screening mammogram in 2010 for further investigation and should have been in 2012.
However, while two of the radiologists involved in reading the 2010 and 2012 screens apologised to Yeoman, a senior Southern DHB clinician, who was one of the two readers of both mammograms, has not.
While Deputy Health and Disability Commissioner Meenal Duggal's assessment of Yeoman's complaint about her treatment found DHB radiologists' errors of perception were not inconsistent with an appropriate standard of care, she asked two of the three radiologists involved to reflect on their approach and consider apologising. (The third had already done so.)
One of them eventually apologised, but the other did not.
He is no longer involved with reading screening mammograms but has read some of Yeoman's other scans.
Asked about the DHB's stance on apologies from clinicians suggested by the HDC, chief executive Chris Fleming said the board expected staff to apologise but was limited in its ability to insist that they do so.
He did not accept a clinician's lack of apology suggested the board and its staff were not treating complaints to the HDC with appropriate seriousness, saying all were investigated thoroughly and the board devoted significant resources to trying to resolve and learn from them.
Yeoman acknowledges that an apology now would be meaningless.
Yeoman was particularly moved by the acknowledgement of the distress to her family in the apology from a North Island woman radiologist who had been one of the readers of her 2012 mammogram. That acknowledgement had made the apology so much more meaningful because her situation did affect her whole family.
"It had a powerful effect on me and I immediately wanted to hug this woman! I felt acknowledged, valued, affirmed and taken seriously. To this day, that apology continues to work its magic in me."
She had appreciated the significant apology from the board and the level of detail provided in the report on its investigation of her situation. Knowing who had done what and when was helpful in allaying her suspicions.
"It meant I could put it to rest to some extent. Knowledge is power. I'd be looking at everybody suspiciously forever, otherwise."
She also relished being invited to discuss her case with lead surgeon of BreastScreen Aotearoa (Otago /Southland) Michael Landmann and more recently with the board's chief medical officer Nigel Millar, in meetings where the discussions were frank and unhurried.
Yeoman considers those receiving medical treatments should be much more proactive about questioning what is being done to them and not just passive participants in their healthcare. If they didn't feel confident raising matters alone, they should involve a support person.
She said the combination of full information given, and full apology "from that good woman, and the SDHB on behalf of `the system', have empowered me and helped me to lay down my bitterness, anger and suspicion".
"It is no mere cliche to say honesty is the best policy. The old adage holds that the truth indeed sets us free. I am convinced the apologies I received, and all apologies potentially, have the power to turn our hearts and minds around into healthy spaces. That has left me free to redirect my energy into living as well as I can for as long as I can."
The Health and Disability Commissioner's office, asked how common a lack of apology was when it was suggested by the office, would not comment on the specific case, but stated there was a very high level of compliance with the commissioner's recommendations.
In the year from July 2016, providers complied with 99.6 % of the educational comments or recommendations of the HDC.
Apologies should involve more than an expression of regret. They were about acknowledging responsibility for the error made, the impact on the complainant and the steps taken to avoid such errors in the future.
"Apologies are usually well received by patients when made in a meaningful or heartfelt manner. Conversely, a refusal or failure to apologise, or an apology that is insincere can serve to escalate the problem."
In response to a question about how a failure to apologise appeared to the patient, Mr Fleming said even with a thorough investigation complainants may feel let down by the board or board staff.
"This is understandable. Whilst the DHB tries to address concerns and provide remediation where possible, this does not always meet a complainant's expectations or resolve their concerns."