Apologies in the healthcare system: From clinical medicine to public health Academic Article uri icon

abstract

  • I INTRODUCTION In recent years, both formal and informal initiatives have promoted the inclusion of apologies in medical education and clinical practices. Many countries have even regulated medical apologies through law. Although there has been much discussion of the potential for apology to promote efficiency and the conditions for a successful apology, the focus has mainly remained the doctor-patient relationship. (1) The literature and many intervention programs have focused on the interactions between doctors and patients after a medical mistake has occurred or some harm has resulted. These interactions have been conceptualized in individualistic settings, with almost no discussion of the collective and cultural dimensions of apology. Moreover, no reference has been made to cases of apology following collective trauma caused by public health activities. These cases involve state activities such as human experimentation or public health interventions that went wrong and are fundamentally different from the usual doctor-patient interaction. In this article, we explore the role of apologies in healthcare systems from a broader perspective. The article begins by exploring the current state of apology within the healthcare system and tries to point out the limitations of the current individualistic point of view under which medical apologies are conceptualized. The article offers to overcome these limitations and enrich the existing discourse by referring to the cultural and collective aspects of apology. It addresses the significance of apology in terms of social solidarity and demonstrates the ways in which each apology situation entails a clash between cultural identities. Next, the main part of the article expands the debate on apology by presenting a public health perspective of apologies following collective traumatic events such as the application of sterilization laws or flawed human experimentations in various settings. The article shows how some public health apologies have failed to address the cultural dimension of a healthcare problem and how an emphasis on this dimension can help the public health practice of apology. Finally, the article returns to apologies in the clinical setting and shows the relevance of culture and identity concerns in this more common context. We claim that the public health perspective of apologies should enrich discussion of the more individualistic-oriented clinical medical apologies. Our analysis also has implications for introducing health-related apologies into medical and legal education and everyday practices. II APOLOGIES IN THE HEALTHCARE SYSTEM: CONDITIONS AND LIMITATIONS A. Apologies and the Law Apology is traditionally considered as a private act and usually not encouraged or enforced by legal institutions. (2) Apology is considered an aspect of interpersonal relationships, while the role of modern law is to externalize broken interpersonal relationships when individuals are unable to settle disputes on their own. (3) The notion of the rule of law is based on alienated relationships between separate individuals who are governed by law and possess legal rights. (4) Apology, under a classic formal perception of law, is unnecessary since the legal determination of rights is supposed to balance the wrong by giving a remedy and officially regulating the relationship between the parties. Apology is usually presented as a speech act--an act that a speaker performs by uttering words that produce a particular effect in the addressee. (5) Yet apology can fail or succeed depending on whether basic conditions are met. Apology as a speech act in modern culture (6) requires a few conditions (7) in order to be authentic and achieve full expression. The conditions of apology are usually stipulated as follows: (8) 1. Acknowledgement that a legitimate rule, moral norm, or social relationship was broken. Proper acknowledgement of the offense includes the identity of the offender and appropriate details of the offense. …

publication date

  • January 1, 2011