You can listen to the full conversation on which this article is based as part of the Risk Bites Ireland series here: Dental Protection Ireland | Podcast on Spotify 

Apologising is something we all recognise as inherently difficult. In dentistry, it can feel even more complex, laden with fear of litigation, concern about reputation and the discomfort of acknowledging that something has gone wrong. 

Why apologies matter in dental practice 

Dr Nuala Carney has a particular interest in the subject of apologies and open disclosure. Her interest began in 2018 when she completed her master’s dissertation in medical law, examining whether open disclosure should be made mandatory in Ireland. 

According to Dr Carney, the disclosure of adverse events continues to be a highly topical and often controversial issue worldwide. Healthcare systems everywhere struggle to balance transparency with the need to protect clinicians, all while seeking to improve patient safety. Despite differences in language, culture and legislation, the research reveals remarkably consistent themes: perfectionism and peer pressure, fear of litigation and reputational damage, and – centrally – the difficulty of saying sorry. 

The cultural barriers to saying sorry 

“Most clinicians can relate to the discomfort of acknowledging an error. No one likes to feel they have made a mistake,” Dr Carney states. “In Ireland in particular, the fear of litigation remains strong. Yet research shows that the act of apologising is key. It is often the gateway to overcoming other barriers, including the fear of humiliation and the wider culture of perfectionism that affects medicine and dentistry.” 

“From the patient’s perspective, trust lies at the heart of every successful healthcare encounter, but this trust is fragile. Patients are deeply aware of the power imbalance in professional relationships. When something goes wrong, this imbalance is the first thing they seek to challenge. Feelings of hurt, vulnerability and anger can be strong and entirely understandable.” 

Does saying sorry increase legal risk? 

Many clinicians worry that apologising might be interpreted as an admission of liability, and there is a persistent belief that organisations such as Dental Protection advise against saying sorry. As Dr Carney stresses, this is simply untrue. 

“An expression of regret, such as ‘I am so sorry that you experienced pain after the extraction’, is not an admission of liability.” 

“A statement that explicitly accepts fault – for example, ‘I am sorry I took out the wrong tooth’ may be, and this is where it is wise to seek advice.” 

Being open and honest when an error has occurred is both a moral and ethical obligation. However, clinicians should reach out to Dental Protection if they are uncertain about what to say, how to manage discussions about fees or how a patient might interpret their actions. Dental Protection’s essential skills workshops, including Mastering Adverse Outcomes, provide structured opportunities to practise these challenging conversations. 

What patients really want after an adverse event 

The assumption that patients immediately seek compensation or litigation is not borne out in the research, according to Dr Carney. Across multiple countries, including the US, Canada and Australia, patients consistently report wanting four things: 

• An explanation of what happened 

• A sincere apology 

• An expression of remorse 

• A fair offer of reparation 

Compensation or litigation usually becomes a consideration only when patients feel they have not been given a genuine apology. When patients have suffered harm resulting in financial loss, pain or ongoing treatment needs, these elements must be acknowledged. Therefore, offering to cover the costs of remedial treatment early on can make a significant difference. When patients meet a ‘stone wall’, frustration and powerlessness often drive them towards legal advice. 

How apologies support healing and restore trust 

An authentic apology can also have a powerful emotional impact. It can defuse anger and reduce a patient’s desire for retribution, but it also does much more. 

A meaningful apology: 

• Restores dignity and makes patients feel respected 

• Demonstrates care and empathy, reinforcing the core values of healthcare 

• Redresses the power imbalance, especially when learning and system improvements are shared 

• Shows humility, which some patients need in order to process their own feelings 

• Confirms the patient was not at fault, while acknowledging that something significant occurred 

• Reopens dialogue, allowing patients to express their emotions and ask questions 

When trust is restored, resolving issues of redress becomes far easier. 

The essential elements of a meaningful apology 

Dr Carney outlines three core components every effective apology must include: 

Sincerity 

Sincerity is conveyed through tone, timing and manner. Early apologies demonstrate remorse and delivering them in person wherever possible shows commitment and effort. 

Content 

The apology must clearly acknowledge responsibility and be specific. This is challenging for clinicians, but it is crucial for patients. It must express empathy, show concern and demonstrate genuine caring. Importantly, it should identify lessons learned and the steps being taken to prevent recurrence. 

Focus 

The apology must centre on the patient, their experience, their emotions and their needs. This requires clinicians to set aside defensiveness, which is often the most difficult aspect of all. 

Practical advice for clinicians facing a difficult conversation 

When something has gone wrong, Dr Carney advises clinicians to: 

• Be empathetic and acknowledge that an unexpected complication has occurred. 

• Avoid discussing further financial charges until the situation is fully understood. 

• Seek advice from Dental Protection early, before making a full apology. 

• Take time to gather the facts, reflect objectively and prepare a complete, meaningful apology. 

• Keep the patient’s needs at the centre of every decision. 

“A rushed or incomplete apology risks appearing defensive and may escalate matters. Thoughtful preparation supports a more constructive outcome for everyone involved.” 

Learning points 

Saying sorry is never easy, but it is one of the most important aspects of maintaining trust, supporting patients and managing adverse outcomes with integrity. With understanding, preparation and the right support, clinicians can approach these conversations with confidence – and ultimately help patients move forward with reassurance and dignity.