An apology is a gift that accepts blame and restores the dignity of the wronged person, Massachusetts psychiatrist and author Aaron Lazare told two Missoula audiences Thursday.
"It makes the world more rational," Lazare told about 100 doctors, nurses and staff members at St. Patrick Hospital at lunchtime. "When we own up, it's a gift we give."
Lazare's advice contradicts the stereotype of the physician, who is traditionally mistreated without apologies in medical school, but trained to be godlike and infallible in American culture. That model is changing rapidly with an international movement toward apology, apology education in medical school and more women in charge in the world, he said; women generally apologize more than men.
"We're witnessing a cultural transformation," he said.
Lazare, who is the longest-serving dean of a medical school in the country, began studying the apology in 1993. He and his assistants searched for and documented every mention of apology in the Washington Post and New York Times from 1990 to 2002. During that time, the numbers doubled.
Lazare also has collected about 25 major journal articles written in recent years. He subscribes to five newspapers and has clipped 1,500 stories about apologies.
Large companies are beginning to acknowledge the power of the apology to customers, motivated at least by its economic value, he said. At least four states have passed legislation that says doctors' apologies and admissions to patients cannot be used against them in court. Medical schools, including the University of Massachusetts, are including apology training in their curricula.
"My bet is in five years, we'll see a radical change," Lazare said.
Research on the effect of doctors' apologies is brand new. But the first analyses seem to show that apologies can reduce lawsuits, medical errors and the high cost of malpractice insurance.
The Associated Press reported last week that in the two years since hospitals in the University of Michigan Health System have been encouraging doctors to apologize to their patients, the system's annual attorney fees have dropped from $3 million to $1 million. Malpractice lawsuits and notices of intent to sue have dropped from 262 in 2001 to about 130 a year.
Medicine is loaded with humiliating diagnoses, Lazare said, gynecological ones among the worst: the "habitual aborter," an "incompetent cervix." Lazare himself felt the sting when a dermatologist diagnosed the growth on his skin as a "senile keratosis." Patients are set from the start to feel shame.
An apology has to be a good one or it can be interpreted as an insult, Lazare said. For instance, President Abraham Lincoln's apology for the "250 years of unrequited toil" of slavery in his second inaugural address is among the greatest in history. Richard Nixon's passive-voice "Mistakes were made" fell short. Janet Jackson's apology for baring her breast at the Super Bowl, "I'm sorry if I offended people," failed because it lacked an acknowledgement that what she did was wrong, Lazare said.
A good apology includes the recognition of wrongdoing, an explanation, an expression of remorse and an offer of reparation. Timing is important - an angry person needs to be heard. And he or she may need time to accept an apology.
"An apology is a negotiation between two people," Lazare said.
A doctor should say to a patient, "Help me understand the damage I have done," and "Tell me what this means to you," Lazare said. When it works, the apology is a healing gift that can change and salvage relationships.
"That transformation is the most miraculous thing," he said.
Reporter Ginny Merriam can be reached at 523-5251 or at gmerriam@missoulian.com
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