Make Apology Normal

Apology after harm should be the rule, not the exception.

The Virtue of Say­ing “We Are Sor­ry”

An apol­o­gy in the face of med­ical harm can be a pow­er­ful and inex­pen­sive tool in the health­care set­ting that affords ben­e­fits to every­one.  As a heal­ing device, it helps to restore the sense of dig­ni­ty and respect so often lost by those who have been harmed. It shows that the insti­tu­tion has learned from the expe­ri­ence, which is some­thing patients and fam­i­lies who have suf­fered pain or loss des­per­ate­ly want to see acknowl­edged.  It can allow them to move for­ward once that mea­sure of account­abil­i­ty is pro­vid­ed. Just as impor­tant, it gives the insti­tu­tion and clin­i­cians involved in the error a way of reclaim­ing their own dig­ni­ty and human­i­ty.

Done the right way, an apol­o­gy can be a pow­er­ful instru­ment of heal­ing.  But it is still the excep­tion when med­ical errors hap­pen.  As Kath­leen Fin­lay, CEO of The Cen­ter for Patient  Pro­tec­tion, observed in The Huff­in­g­ton Post,

There is con­sid­er­able lit­er­a­ture sup­port­ing the apol­o­gy con­cept when things go wrong in health­care, and it has been exten­sive­ly adopt­ed in some Euro­pean coun­tries, where it has been linked to few­er mal­prac­tice law­suits. But in Cana­da, the idea is about as far away from being wide­ly accept­ed as free park­ing is at hos­pi­tals.

The Center’s Apol­o­gy  Pro­to­colSM is a unique, principle-based approach that is now avail­able to meet the needs of con­sci­en­tious and com­pas­sion­ate providers, and espe­cial­ly the patients and fam­i­lies who long for it.

It is a well accept­ed doc­trine of ethics that the test of a person’s char­ac­ter is not whether they make a mis­take, since we all do. It is how one owns up to that mis­take and tries to make it right that is the defin­ing mea­sure of a person’s moral core. Some believe that, done cor­rect­ly, an apol­o­gy is noth­ing less than the deep­est form of com­mu­ni­ca­tion between one human soul and anoth­er.

Enlight­ened providers look­ing for prin­ci­pled out­comes in sit­u­a­tions that have proven chal­leng­ing may wish to con­tact The Cen­ter for Patient  Pro­tec­tion to explore the advan­tages of our Apolo­gy  Pro­to­colSM

 

 

  1. Full Dis­clo­sure and Apology—An Idea Whose Time Has Come

     

    Excerpt from an arti­cle by Lucien Leape, M.D.(2006)

    Apol­o­gy vs dis­clo­sure

    The case for apol­o­gy is very dif­fer­ent from that for dis­clo­sure. Apol­o­gy is not an eth­i­cal right, but a ther­a­peu­tic neces­si­ty. Apol­o­gy makes it pos­si­ble for the patient to rec­og­nize our human­i­ty, our fal­li­bil­i­ty, our remorse at hav­ing caused harm. It “lev­els the play­ing field.” It makes it pos­si­ble for the patient to for­give us. Apol­o­gy is nec­es­sary for heal­ing, for “get­ting over it.” It doesn’t always work. Some­times the patient’s anger is too great for for­give­ness. But heal­ing can­not occur with­out it. To be effec­tive, it must be a true apol­o­gy, in which the care­giv­er takes respon­si­bil­i­ty for the event and shows remorse and a desire to make amends.

    I’m sor­ry this hap­pened to you,” is no sub­sti­tute, for it lacks respon­si­bil­i­ty and remorse. Mak­ing amends should include reim­burse­ment for expens­es as well com­pen­sa­tion for long-term dis­abil­i­ty. Apol­o­giz­ing is also nec­es­sary for heal­ing of the doc­tor or nurse who made the error. They, too, are emo­tion­al­ly trau­ma­tized. They are the “sec­ond vic­tims,” dev­as­tat­ed by hav­ing been the unwit­ting instru­ment that seri­ous­ly harmed anoth­er. They feel shame and guilt that some­times can be over­whelm­ing. Apol­o­giz­ing, express­ing their remorse and desire to make amends, can lead to for­give­ness and heal­ing for them as well. So apol­o­gy is a balm for both the patient and the care­giv­er. It heals their psy­cho­log­i­cal wounds.