Jane R.

Freeman, LISW Morning Report November 14, 2011

Pre-Test
1.

Which emotion is most likely to generate the most destructive response?

Shame b. Guilt c. Embarrassment d. Humiliation
a.

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

is most likely to enhance interpersonal healing?

For the person who was hurt, opportunity to ventilate feelings to the appropriate party b. Dialogue between both parties c. Acknowledgement of fault by the person offering the apology d. Sincerity of the person offering the apology
a.

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

national medical reporting, during the past several years?

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 two decades.
a.

Background
Full disclosure has been encouraged in medicine since

1999 I.O.M. report To Err is Human and JCAHO 2001 safety standards. Unexpected (by some) outcome was reduction in number and cost of health care claims.

Terms
Apology: an acknowledgment of responsibility for an offense coupled with an expression of remorse Offense: A physical or psychological harm caused by an individual or group that could or should have been avoided by ordinary standards of behavior

Structure of Apologies
Acknowledgement of the offense 2. Explanation for committing the offense 3. Expression of remorse, shame, forbearance and humility.
1.
a. b. c. d.

Remorse: deep sense of regret Shame: emotion associated with failing to live up to ones standards Forbearance: commitment to not repeat the offense Humility: state of being humble, not arrogant

4. Reparation

Humiliation

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 induce

shame. 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.

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

Healing Mechanisms
Designation of fault
Assurance of shared values Entering into a dialogue with the offender Reparations A promise for the future

Healing forces in apology: what the offended party wants

98%
87% 85% 71% 69% 12% 2%

to be sincere remorse, regret understand my feelings (empathy) a dialogue expression of shared values of right and wrong retribution (see the offender suffer) tangible compensation (reparations)

Other Aspects of Apologies

Who offers and who receives the apology
Timing of apologies Apology as a negotiation How apologies fail Resistance to apologize

Great bad example

I regret deeply any injuries that may have been done in the course of events that have led to this decision (to resign his presidency). I would say only that if some of my judgments were wrong, and some were wrong, they were made in what I believed at the time to be in the best interest of the nation. Richard M. Nixon August 8,1974

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 and

apologies strengthen, rather than jeopardize, relationships and diminish punitive responses.

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 of the illness or procedure Inadequate communication among treatment team Disparaging or condescending comments

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 ensure that error is not repeated Offer compensation Based on program at Dept of Veterans Affairs Hospital, Lexington, KY

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

Resources
Lazare, Aaron. Apology in Medical Practice. JAMA.

2006; 296: 1401-1404. ____ . Go Ahead, Say Youre Sorry. Psychology Today. September 2009. ____. On Apology. Oxford University Press. 2004.

Post-test
D is the correct answer to all three questions