apology in medical practice
TRANSCRIPT
8/13/2019 Apology in Medical Practice
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Jane R. Freeman, LISW
Morning Report
November 14, 2011
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Pre-Test1. Which emotion is most likely to generate the most
destructive response?
a. Shame
b. Guilt
c. Embarrassment
d. Humiliation
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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
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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.
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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.
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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
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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
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Humiliation
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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”.
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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
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Healing Mechanisms Designation of fault
Assurance of shared values
Entering into a dialogue with the offender Reparations
A promise for the future
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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)
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Other Aspects of Apologies Who offers and who receives the apology
Timing of apologies
Apology as a negotiation How apologies fail
Resistance to apologize
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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
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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.
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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
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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
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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
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Post-testD is the correct answer to all three questions