Disclosure and Apology: Introduction

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Disclosure and ApologyIntroduction

• Darshak M. Sanghavi, MD
• Assistant Professor (Pediatric Cardiology)
• University of Massachusetts Medical School
• Medical columnist, Boston Globe

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The Primal Need for Disclosure

• Excerpts from the Apology line (audio)
• The act of confession and apology is itself a
  creative act an attempt to find meaning in the
  restructuring of ones experience into a moral
  tale. Only by finding a moral can one turn the
  page and move on.- Allan Bridge

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RE Cardinal Laws Apology

• Part of the problem has been the overuse of
  legal and corporate and bureaucratic language,
  and there hasn't been enough casting this in
  evangelical language, not as a mask, but let's
  confess and let's repent and let's atone,'' said
  the Rev. Donald P. Senior, president of Catholic
  Theological Union, a seminary in Chicago.
  ''That's what people are looking for. They don't
  want to hear If mistakes were made' language -
  that makes people's blood boil.''

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Sarasota, FL Elementary School

• Writing an apology letter takes a lot of hard
  thinking about your's and other's feelings. When
  you go to apologize to someone you want to make
  sure that you say/write the right words to
  satisfy that person's emotions. Sometimes it is
  hard for us to accept an apology from others
  that's why when writing this type of letter, it
  is very important that you prove to this person
  that every word you say comes from your heart and
  is really meant to be accepted. (In other words,
  you really mean what you say.)
• The next thing that needs to be acknowledged is
  not only what the problem is but how to solve it.
  Let the reader know that you were wrong and that
  you are sorry. What can you do to make it up to
  that individual? Then you wait for a strong
  reply. At this point you should be able to tell
  whether or not you have made the right decision.
  (Do you feel you have done the right thing?)

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Tuskeegee Syphilis Apology

• President Clinton recounted the injustice done to
  the Study participants and concluded, What was
  done cannot be undone but we can end the silence.
  We can stop turning our heads away. We can look
  at you in the eye, and finally say, on behalf of
  the American people, what the United States
  government did was shameful and I am sorry.
• The President also praised the survivors for
  their spirit of forgiveness, saying, Today all
  we can do is apologize but you have the power.
  Only you have the power to forgive. Your presence
  here shows us that you have shown a better path
  than your government did so long ago.

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What makes for good and bad apologies?

• Good apologies
• Acknowledgment of responsibility and allowing
  refusal of apology
• Sincere remorse
• May or may not include explanations or promises
  to change
• Bad apologies
• Apologia
• Blaming victim, minimizing the harm, or
  deflecting the apology to the wrong party
• Only expressing sorrow for suffering

Adapted from Lazare, On Apology
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A Familys Experience at a Boston Hospital

• Son died during hospitalization for seizures
• What do families remember?
• (Audio excerpt)

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Conclusion The Pitfalls of Apology

• Can doctors and other health providers be taught
  to disclose and apologize effectively?
• One patients final worry (audio)