Social and psychological determinants of doctors’ willingness to apologize after medical errors: a cross-sectional survey applying the theory of planned behavior

Abstract Background Medical errors pose a significant challenge to patient safety and the quality of the doctor-patient relationship. Open communication and apologies following medical errors are ethically sound and crucial for maintaining trust and restoring the relationship. This study investigated physicians’ perception of social and psychological factors influencing their intentions to apologize for medical errors by applying the Theory of Planned Behavior principles via a Structural Equation Model (SEM). Method Participants were 281 physicians aged between 26 and 67 years (mean ± SD: 46 ± 8 years), 62% were males with an average working experience of 20 ± 8 years. They were employed in the public hospital network of Southern Switzerland. Results The SEM analysis showed that behavioral control and positive attitudes toward apologizing were stronger predictors of the intention to apologize, although social norms remained a significant predictor. Positive attitudes and behavioral control also mediated the relationship between beliefs and intention. The beliefs about the impact of an apology on the doctors’ professional identity were also directly linked to the intention to apologize. Discussion The findings indicate that positive attitudes toward apologizing and physicians perceived behavioral control, namely their sense of ability and confidence to engage in such communication, are important predictors of this intention. Moreover, the findings suggest that protecting professional identity and reinforcing supportive social norms within healthcare settings may encourage more open communication following medical errors. These results complement existing communication frameworks that aim to guide and support apology practices in clinical contexts.