In the last post, we reviewed the apology process following patient safety incidents. As happens with all mundane interactions, offering an apology is usually associated with the seeking of forgiveness from the injured party, and this is the case with physicians who suffer from the heavy emotional toll of patient safety incidents. Nancy Berlinger made this point in her paper titled Resolving harmful medical mistakes-is there a role for forgiveness?; there, she pointed out that such physicians often have a strong ‘desire for forgiveness‘ from their injured patients.
The process by which the injured party forgives the physician is however complicated and frequently drawn out; indeed Berlinger warned that even after disclosure, apology, and compensation have occurred, ‘the physician should not expect to hear the words “I forgive you” from an injured patient or family. The reason she gave for this is that ‘asking for forgiveness may be oppressive to a patient or family still grappling with the fact of the harm, the impact of the harm, and their own emotional response to the harm’. In such circumstances, she said, forgiveness would be ‘a premature, formulaic response’.
In their paper titled Guilty, afraid, and alone-struggling with medical error, Tom Delbanco and Sigall Bell also agreed that apology and disclosure ‘may be insufficient to elicit forgiveness’ because forgiveness also requires ‘shared understanding, rekindled trust, acceptance, and closure‘. Because ‘the process of forgiveness may be the work of months or years‘, Berlinger advised any physician seeking forgiveness to focus, at least in the short-term, on ‘self-forgiveness‘, and to do this by ‘working to understand his or her role in an incident that slipped beyond the envelope of safety‘.
In the next post, we will look at compensation after patient safety incidents.