FEATURE
SORRY , BUT LESS IS MORE AUTHOR John David Kolter , MD
When Elton John released Blue Moves on New Years Day 1976 , he declared , on his sole hit from the album , what many would readily acknowledge : “ Sorry Seems to be the Hardest Word ,” indeed . While John sings regretfully about a disintegrating relationship on the B-side ballad , he acknowledges the weight and significance of this simple word . Perhaps that very weight , capable of altering the velocity of any fraught human interaction , is precisely why sorry is so difficult to say . Saying “ sorry ” may be hard , but , with my apologies to Sir Elton , sorry can be said in empathy with ease , though the words that come next may just be all the more daunting . Often , we feel the need to carry on after we utter “ sorry ,” as if the words after the hardest word will somehow be more substantial . The hardest words may just be the ones we don ’ t say .
We say “ sorry ” in so many contexts in the English language : to express regret , to excuse ourselves and to show empathy , to name a few . The empathetic sorry is more akin to the Italian mi dispiace , quite literally “ displeasing to me .” In medicine , we use the word sorry in varied ways as well . “ Sorry ” can convey our regrets for unintended events or , dreadfully , overt mistakes . More often , “ sorry ” hopefully is used to convey empathy . We deal in the sick and there is no shortage of need for empathy for the displeasures of our patients . Saying sorry to a lover or spouse may fix an argument and salvage a relationship but it won ’ t fix a patient ’ s suffering or cure their illness . Empathy will , however , solidify and humanize our relationship with our patients and it does not require accompanying verbosity . Therein lies the rub . Why do we often feel the need to keep talking after we say sorry , be it for regret or empathy ? Could it be that we as physicians , by nature and training , have a need and desire to fix problems ?
After we say “ sorry ,” we as physicians work our way into solutions , our bread and butter . Problem solving is part of our training , from the basic sciences and mathematics to internship and residency training . As a primary care physician , I spend much of my day as a medical border collie , herding unwieldy lists of medical problems into organized and integrated plans . When a patient presents a vexing list of life occurrences , I suppose I , for instance , may think if I keep talking and offer solutions after an offer of empathy then I may just be able to solve the problems conveyed . Surely this would alleviate more suffering and displeasure and , hence , the need to offer an empathetic “ sorry ” again in the future . However , this simply is not realistic when it comes to the ups and downs of our patient ’ s lives . Just as Elton John was right in declaring sorry to be the hardest word to utter in matters of passion , we know with similar assuredness we can ’ t solve all the issues in our patient ’ s lives after a decidedly more easily uttered offer of empathy . ( continued on page 16 ) JUNE 2021 15