Beyond Disclosure: Seeking Forgiveness

Abstract

In a Boston hospital delivery unit, a series of small mistakes—compounded by everyday stressors, personality conflicts, and the harried schedules familiar to every health care professional—culminated in the loss of a newborn and the serious compromise of the mother's health. Sachs, who tells this extraordinary story in JAMA ,1 should be commended for his discussion of mistakes in health care, the costs to everyone involved, and this particular medical team's generative approach to improving their practices. But what makes the article extraordinary is its focus on offering an apology. In doing so, the involved health care professionals moved into a position of seeking forgiveness . Forgiveness themes have surfaced, albeit infrequently, in the health care literature. One notable example is a widely read study—written by medical sociologist Charles Bosk and published in the book titled Forgive and Remember: Managing Medical Failures 2—documenting surgical error in the 1970s. The term “forgiveness” might be stumbled upon, rarely if at all, in professional ethics texts, especially those few that are virtue-based in approach or written within the context of particular religious ethics approaches. The concept of forgiveness is glaringly absent, however, in the medical and nursing literature and in the curricular materials of those professional education programs. But the medical and nursing professions are not unique. Apology and forgiveness themes are seldom, if ever, the focus of ethics cases in professional physical therapist education or plenary sessions at APTA meetings. Apology just isn't in the clinical vocabulary or, for that matter, in the clinician's line of vision. Why is the idea of apologizing absent from the health care professions at a time when taking precautions to prevent mistakes, being reflective, and being accountable are increasing in the literature and guidelines about professionalism? I believe that apology is largely absent from the …