Article

Subtracting insult from injury: Addressing cultural expectations in the disclosure of medical error

Johns Hopkins University, Baltimore, Maryland, United States
Journal of Medical Ethics (Impact Factor: 1.51). 03/2005; 31(2):106-8. DOI: 10.1136/jme.2003.005538
Source: PubMed

ABSTRACT

This article proposes that knowledge of cultural expectations concerning ethical responses to unintentional harm can help students and physicians better to understand patients' distress when physicians fail to disclose, apologize for, and make amends for harmful medical errors. While not universal, the Judeo-Christian traditions of confession, repentance, and forgiveness inform the cultural expectations of many individuals within secular western societies. Physicians' professional obligations concerning truth telling reflect these expectations and are inclusive of the disclosure of medical error, while physicians may express a need for self-forgiveness after making errors and should be aware that patients may also rely upon forgiveness as a means of dealing with harm. The article recommends that learning how to disclose errors, apologize to injured patients, ensure that these patients' needs are met, and confront the emotional dimensions of one's own mistakes should be part of medical education and reinforced by the conduct of senior physicians.

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Available from: Albert W Wu, Feb 18, 2015
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    • "Understanding cultural expectations such as truth telling and forgiveness can provide insight into patients needs [46]. Just as secular Western societies continue to be influenced by Judo-Christian norms concerning social ethics [46], Arabic and Islamic societies are still influenced by Islamic social ethics which shares many foundational values with Judaism and Christianity [48]. Forgiveness and truth telling are praised in several verses of Quran, for example: "Be quick in the race for forgiveness from your Lord, and for a Garden whose width is that (of the whole) of the heavens and of the earth, prepared for the righteous. "
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    ABSTRACT: Disclosure of near miss medical error (ME) and who should disclose ME to patients continue to be controversial. Further, available recommendations on disclosure of ME have emerged largely in Western culture; their suitability to Islamic/Arabic culture is not known. We surveyed 902 individuals attending the outpatient's clinics of a tertiary care hospital in Saudi Arabia. Personal preference and perceptions of norm and current practice regarding which ME to be disclosed (5 options: don't disclose; disclose if associated with major, moderate, or minor harm; disclose near miss) and by whom (6 options: any employee, any physician, at-fault-physician, manager of at-fault-physician, medical director, or chief executive director) were explored. Mean (SD) age of respondents was 33.9 (10) year, 47% were males, 90% Saudis, 37% patients, 49% employed, and 61% with college or higher education. The percentage (95% confidence interval) of respondents who preferred to be informed of harmful ME, of near miss ME, or by at-fault physician were 60.0% (56.8 to 63.2), 35.5% (32.4 to 38.6), and 59.7% (56.5 to 63.0), respectively. Respectively, 68.2% (65.2 to 71.2) and 17.3% (14.7 to 19.8) believed that as currently practiced, harmful ME and near miss ME are disclosed, and 34.0% (30.7 to 37.4) that ME are disclosed by at-fault-physician. Distributions of perception of norm and preference were similar but significantly different from the distribution of perception of current practice (P < 0.001). In a forward stepwise regression analysis, older age, female gender, and being healthy predicted preference of disclosure of near miss ME, while younger age and male gender predicted preference of no-disclosure of ME. Female gender also predicted preferring disclosure by the at-fault-physician. We conclude that: 1) there is a considerable diversity in preferences and perceptions of norm and current practice among respondents regarding which ME to be disclosed and by whom, 2) Distributions of preference and perception of norm were similar but significantly different from the distribution of perception of current practice, 3) most respondents preferred to be informed of ME and by at-fault physician, and 4) one third of respondents preferred to be informed of near-miss ME, with a higher percentage among females, older, and healthy individuals.
    Full-text · Article · Oct 2010 · BMC Medical Ethics
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    • "Yet, forgiveness issues still exist for physicians even if they are not allowed to communicate with families (see Gerber 1990). For example, one physician stated that at times physicians need self-forgiveness, which was described as freedom from guilt and self-hatred over mistakes (Berlinger and Wu 2005). Thus, although none have been investigated empirically, self-forgiveness interventions could help physicians deal with medical mistakes. "
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    ABSTRACT: The extant data linking forgiveness to health and well-being point to the role of emotional forgiveness, particularly when it becomes a pattern in dispositional forgivingness. Both are important antagonists to the negative affect of unforgiveness and agonists for positive affect. One key distinction emerging in the literature is between decisional and emotional forgiveness. Decisional forgiveness is a behavioral intention to resist an unforgiving stance and to respond differently toward a transgressor. Emotional forgiveness is the replacement of negative unforgiving emotions with positive other-oriented emotions. Emotional forgiveness involves psychophysiological changes, and it has more direct health and well-being consequences. While some benefits of forgiveness and forgivingness emerge merely because they reduce unforgiveness, some benefits appear to be more forgiveness specific. We review research on peripheral and central nervous system correlates of forgiveness, as well as existing interventions to promote forgiveness within divergent health settings. Finally, we propose a research agenda.
    Full-text · Article · Sep 2007 · Journal of Behavioral Medicine
    • "Yet, forgiveness issues still exist for physicians even if they are not allowed to communicate with families (see Gerber 1990). For example, one physician stated that at times physicians need self-forgiveness, which was described as freedom from guilt and self-hatred over mistakes (Berlinger and Wu 2005). Thus, although none have been investigated empirically, self-forgiveness interventions could help physicians deal with medical mistakes. "
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    ABSTRACT: Our purpose in this chapter is to address the possible health connections of forgiveness, which we view as one way of expressing altruism (see Post, 2003). Because attempts to forgive may not always be born out of purely altruistic concerns, and definitions of forgiveness vary, it is important to present our view of forgiveness and to distinguish it from what it is not. Links with health are likely to hinge on a view of forgiveness that distinguishes it from pseudoforgiveness. For example, it is important not to confuse granting forgiveness with forbearing (McCullough, Fincham, & Tsang, 2003), denying, ignoring, minimizing, tolerating, condoning, excusing, forgetting the offense, suppressing one's emotions about it, or reconciling (see Baskin & Enright, 2004; Enright & Human Development Study Group, 1991). (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    No preview · Chapter · Jun 2007
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