In anticipation of EM Cases Episode 91 Knee Injuries Pearls and Pitfalls Dr. Arun Sayal, creator of the CASTED course, tells his Best Case Ever concerning a missed fracture and apologizing to patients. Dr. Sayal reminds us of two basic concepts that are all too often skipped over in our assessment of minor injuries: “if in doubt, examine above and below the joint” and “ask the patient where it hurts the most and if you can’t reproduce the pain at the point of maximal tenderness, look for another source”. His story is a reminder of the importance of not rushing the physical exam in patients with minor injuries. He then goes on to explain the effect of apologizing to the patient for a missed fracture. On the upcoming episode Dr. Sayal and Dr. Hossein Mehdian will answer such questions as: When should we suspect a spontaneously reduced knee dislocation? Do all patients suspected of a spontaneous knee dislocation require a CT angiogram to rule out vascular injury? Which patients with a low energy mechanism are at risk for knee dislocation and vascular complications? How can you increase the accuracy of the active straight leg raise in assessing for quadriceps and patella tendon rupture? What is an easy way to identify patella baja and patella alta? What are the indications for ultrasound of the knee? What are the true indications for a knee immobilizer and how can knee immobilizers kill our patients? and many more…

Published by Anton Helman, January 2017

Tips on Apologizing to Patients When Disclosing Adverse Events

Adapted from The Canadian Medical Protective Agency

  • As soon as is reasonable to do so, tell the patient the known facts in a gentle, non-rushed manner
  • Discuss the current options for dealing with the medical condition
  • Consider expressing your feelings of concern, empathy and regret
  • You may then apologize and acknowledge responsibility



CMPA Duties and responsibilities – Expectations of physicians in practice. How to apologize when disclosing adverse events to patients. Originally published September 2006 / Revised May 2008; IS0664-E.

Roberts RG. The art of apology: when and how to seek forgiveness. Fam Pract Manag. 2007;14(7):44-9. Full PDF

How should a physician apologize after a medical error? on KevinMD