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The Psychology of Apology

Hard as it is to admit an error to the world, it can be even harder for a doctor to admit one to herself.

Anita Slomski // Fall 2007
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The prospect of a lawsuit might be enough to keep a doctor who has made a mistake mum—or there might be more at play. Hard as it is to admit an error to the world, it can be even harder to admit one to oneself. Though critics may blast doctors for overweening egos, the underlying psychology is more complicated, says John Banja, a professor at the Center for Ethics at Emory University in Atlanta and author of Medical Errors and Medical Narcissism.

All professionals need a healthy dose of narcissism to be competent and take pride in doing their jobs well, Banja says. For that reason, a medical error sparks internal conflict, threatening a physician’s perception of competence. While those with healthy egos will be more likely to overcome the blow and to prevent their self-assuredness from interfering with being ethical or empathic, those who need to preserve their image at all costs will externalize—and thus rationalize—an error. “They might claim the patient won’t understand the explanation or that someone else was more responsible,” says Banja.

Not surprisingly, this drive for self-preservation can yield the opposite effect. “Patients interpret evasiveness as the doctor being more interested in his or her own feelings than in theirs,” says Banja. Patients then become angry that they’re being treated dishonestly. “It’s in the doctor’s best interest to disclose and apologize rather than stonewall,” he says.

But physicians may need plenty of coaching to understand how to have those conversations with patients. “We make a huge mistake in thinking that because a person has the intellectual ability to get into medical school, he or she will be emotionally intelligent enough to deal with medical errors,” says Banja.

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The Hardest Word

Doug Wojcieszak, Sorry Works!

A timely apology and adequate compensation may persuade patients not to sue over medical mistakes. So why do most hospitals stonewall?

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