Medical practices that replace excuses with solutions tend to earn more trust from their patients, according to Dr. Neil Baum, a clinical urology professor at Tulane University. The difference between an explanation and an excuse, he argues, often determines whether a patient walks away satisfied or frustrated.
He describes what he calls a “Moment of Misery.”
A patient complaint — and contrasts it with a “Moment of Magic,” which happens when a receptionist solves the problem on the phone with a positive attitude and no excuses.
The concept comes from a book.
It focuses on solving problems.
It motivates patients to share their experiences.
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An excuse, by definition, is “a reason or explanation put forward to defend or justify a fault or offense,” according to Oxford Languages.
Vocabulary.com puts it more simply: “an explanation for something that went wrong.”
Baum argues that excuses often mask deeper reasons for inaction. Common ones include “We were short of staff,” “I didn’t have enough time,” or “The report is not available.” These phrases, he says, tend to hide the real issue — sometimes that the practice assumes patients will be understanding and tolerate mistakes.
Excuses hurt patient trust. They frequently come from a fear of failure, a fear of not being good enough, or a fear of retribution, Baum writes. They protect people from facing their own shortcomings. But the more excuses a practice makes, the less it grows, and the more it stays stuck in a cycle of avoidance.
Practices that rely on excuses tend to have lower patient satisfaction scores and fewer positive reviews on online reputation sites, according to the report. Every excuse erodes credibility, which leads to a loss of trust in both the doctor and the practice.
There is a difference between an explanation and an excuse, Baum notes. An explanation about why a problem happened is acceptable — but it should be followed with “Here’s what we are going to do about it.” That distinction, he says, ensures the patient sees it as accountability, not deflection.
Turning complaints into credit requires taking responsibility, even when the problem isn’t your fault, Baum writes. “If you tell the complainer, ‘Here’s what I’m going to do about it,’ then the patient knows you’re not trying to shirk your ownership of the problem.”
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That approach turns a complaint into an opportunity. The clinic gets credit for good service, and the patient feels heard. Baum suggests that providing an explanation is acceptable — but it shouldn’t be an excuse. The follow-up matters: “Here’s what we are going to do about it.”
Some practices might find that shifting from excuse-making to solution-finding requires a cultural change. Staff need to feel safe reporting when an excuse was made, without fear of retribution, and that conversation should happen in private, not in front of patients.
Accountability over avoidance is key. He recommends making a clear commitment that the practice and its staff will not make excuses. When a patient complains, the response should acknowledge the problem and promise a timely solution — followed by actual follow-through.
“Excuses maintain the status quo,” Baum writes.
“Solutions move patient care forward.”
By focusing on solutions, even small actions can create a positive impact. The goal is to provide patients with a healthcare experience that feels supportive and respectful — not one that leaves them wondering if anyone is listening.
