8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 1/21

 Jane R. Freeman, LISW

Morning Report

November 14, 2011

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 2/21

Pre-Test1.  Which emotion is most likely to generate the most

destructive response?

a. Shame

b. Guilt

c. Embarrassment

d. Humiliation

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 3/21

Pre-test2. For recipients of an apology, which of these response

is most likely to enhance interpersonal healing?

a. For the person who was hurt, opportunity to ventilatefeelings to the appropriate party

b. Dialogue between both parties

c.  Acknowledgement of fault by the person offering theapology

d. Sincerity of the person offering the apology

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 4/21

Pre-test3.  What is the frequency of apologies, based on

national medical reporting, during the past several years?

a. Has been consistent during past two decades.

b. Has been diminishing during past two decades.

c. Has been irregular during past 2 decades.

d. Has been consistently increasing during past twodecades.

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 5/21

Background Full disclosure has been encouraged in medicine since

1999 I.O.M. report “To Err is Human” and JCAHO 2001safety standards.

Unexpected (by some) outcome was reduction innumber and cost of health care claims.

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 6/21

Terms Apology:

an acknowledgment of responsibility for an offensecoupled with an expression of remorse

Offense:

 A physical or psychological harm caused by anindividual or group that could or should have beenavoided by ordinary standards of behavior

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 7/21

Structure of Apologies1.  Acknowledgement of the offense

2. Explanation for committing the offense

3. Expression of remorse, shame, forbearance andhumility.a. Remorse: deep sense of regret

b. Shame: emotion associated with failing to live up to one’sstandards

c. Forbearance: commitment to not repeat the offense

d. Humility: state of being humble, not arrogant

4. Reparation

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 8/21

Humiliation

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 9/21

Humiliation: 69% of reasons for apologies Feeling disrespected.

 A loss of stature or image.

Fail to recognize the dignity of another

 An event perceived to cause loss of honor and induceshame.

Feeling powerless.

Being unjustly forced into a degrading position. Ridicule, scorn, contempt at the hands of others.Root: from Latin humilis, low, lowly, from humus, ground . Literally,

“reducing to dirt”. 

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 10/21

Healing Mechanisms Restoration of self-respect and dignity

Feeling cared for and cared about

Restoration of power Suffering in the offender

 Validation that the offense occurred

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 11/21

Healing Mechanisms Designation of fault

 Assurance of shared values

Entering into a dialogue with the offender Reparations

 A promise for the future

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 12/21

Healing forces in apology: what

the offended party wants 98% to be sincere

87% remorse, regret

85% understand my feelings (empathy) 71% a dialogue

69% expression of shared values of right and wrong

12% retribution (see the offender suffer) 2% tangible compensation (reparations)

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 13/21

Other Aspects of Apologies Who offers and who receives the apology

Timing of apologies

 Apology as a negotiation How apologies fail

Resistance to apologize

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 14/21

Great bad example“I regret deeply any injuries that may have been done in

the course of events that have led to this decision (toresign his presidency). I would say only that if some ofmy judgments were wrong, and some were wrong, they were made in what I believed at the time to be in thebest interest of the nation.” 

Richard M. Nixon August 8,1974

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 15/21

Resistance to Apologize Fear of consequences

complaints to state board

malpractice suits loss of professional self-image, shame, reputation

Current evidence suggests admissions of harm andapologies strengthen, rather than jeopardize,

relationships and diminish punitive responses.

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 16/21

Offenses other than medical errors Excessive waiting times

Failure to address the patient by his/her preferred

name Inappropriate body exposure of patient

Failure to listen and adequately explain the nature ofthe illness or procedure

Inadequate communication among treatment team Disparaging or condescending comments

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 17/21

The Sorry Works! Coalition Protocol*If standard of care not met in adverse event, then

providers and their insurer should:

 Apologize to patient/family

 Admit fault Provide an explanation of what happened

Provide explanation of what hospital will do to ensurethat error is not repeated

Offer compensation

Based on program at Dept of Veterans Affairs Hospital,Lexington, KY

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 18/21

Take home points Effective apology is a profound healing process

Can restore damaged relationships or strengthen

relationships For the offender-can diminish guilt, shame and fear of

retaliation

For the offended-can remove a grudge, facilitating

forgiveness and reconciliation

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 19/21

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 20/21

 

8/13/2019 Apology in Medical Practice

http://slidepdf.com/reader/full/apology-in-medical-practice 21/21

Post-testD is the correct answer to all three questions