Disclosure and Apology:Disclosure and Apology:IntroductionIntroduction

Darshak M. Sanghavi, MDDarshak M. Sanghavi, MD

Assistant Professor (Pediatric Cardiology)Assistant Professor (Pediatric Cardiology)University of Massachusetts Medical SchoolUniversity of Massachusetts Medical School

Medical columnist, Boston GlobeMedical columnist, Boston Globe

The Primal Need for DisclosureThe Primal Need for Disclosure

Excerpts from the Excerpts from the “Apology line” (audio)“Apology line” (audio)

““The act of confession and The act of confession and apology is itself a creative apology is itself a creative act: an attempt to find act: an attempt to find meaning in the meaning in the restructuring of one’s restructuring of one’s experience into a moral experience into a moral tale. Only by finding a tale. Only by finding a moral can one turn the moral can one turn the page and move on.”page and move on.”- - Allan BridgeAllan Bridge

RE: Cardinal Law’s ApologyRE: Cardinal Law’s Apology

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

Sarasota, FL Elementary SchoolSarasota, FL Elementary School

Writing an apology letter takes a lot of hard thinking about your's and 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 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 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 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 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 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 heart and is really meant to be accepted. (In other words, you really mean what you say.)mean what you say.)

The next thing that needs to be acknowledged is not only what the 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 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 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 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 be able to tell whether or not you have made the right decision. (Do you feel you have done the right thing?)you feel you have done the right thing?)

Tuskeegee Syphilis ApologyTuskeegee Syphilis Apology

President Clinton recounted the injustice done to the Study President Clinton recounted the injustice done to the Study participants and concluded, “What was done cannot be participants and concluded, “What was done cannot be undone but we can end the silence. We can stop turning undone but we can end the silence. We can stop turning our heads away. We can look at you in the eye, and finally our heads away. We can look at you in the eye, and finally say, on behalf of the American people, what the United say, on behalf of the American people, what the United States government did was shameful and I am sorry.”States government did was shameful and I am sorry.”

The President also praised the survivors for their spirit of The President also praised the survivors for their spirit of forgiveness, saying, “Today all we can do is apologize but forgiveness, saying, “Today all we can do is apologize but you have the power. Only you have the power to forgive. you have the power. Only you have the power to forgive. Your presence here shows us that you have shown a better Your presence here shows us that you have shown a better path than your government did so long ago.”path than your government did so long ago.”

What makes for good What makes for good and bad apologies?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

A Family’s Experience at a A Family’s Experience at a Boston HospitalBoston Hospital

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

Conclusion: Conclusion: The Pitfalls of ApologyThe Pitfalls of Apology

Can doctors and other health providers be Can doctors and other health providers be taught to disclose and apologize taught to disclose and apologize effectively?effectively?

One patient’s final worry (audio)One patient’s final worry (audio)