1. Disclosure and Apology:Introduction Darshak M. Sanghavi, MD Assistant Professor (Pediatric Cardiology) University of Massachusetts Medical School Medical columnist, Boston Globe

2. Excerpts from the “Apology line” (audio) “The act of confession and apology is itself a creative act: an attempt to find meaning in the restructuring of one’s experience into a moral tale. Only by finding a moral can one turn the page and move on.”- Allan Bridge The Primal Need for Disclosure

7. RE: Cardinal Law’s Apology • “Part of the problem has been the overuse of legal and corporate and bureaucratic language, and there hasn't been enough casting this in evangelical language, not as a mask, but let's confess and let's repent and let's atone,'' said the Rev. Donald P. Senior, president of Catholic Theological Union, a seminary in Chicago. ''That's what people are looking for. They don't want to hear `If mistakes were made' language - that makes people's blood boil.''

8. Sarasota, FL Elementary School • Writing an apology letter takes a lot of hard thinking about your's and other's feelings. When you go to apologize to someone you want to make sure that you say/write the right words to satisfy that person's emotions. Sometimes it is hard for us to accept an apology from others; that's why when writing this type of letter, it is very important that you prove to this person that every word you say comes from your heart and is really meant to be accepted. (In other words, you really mean what you say.) • The next thing that needs to be acknowledged is not only what the problem is but how to solve it. Let the reader know that you were wrong and that you are sorry. What can you do to make it up to that individual? Then you wait for a strong reply. At this point you should be able to tell whether or not you have made the right decision. (Do you feel you have done the right thing?)

9. Tuskeegee Syphilis Apology • President Clinton recounted the injustice done to the Study participants and concluded, “What was done cannot be undone but we can end the silence. We can stop turning our heads away. We can look at you in the eye, and finally say, on behalf of the American people, what the United States government did was shameful and I am sorry.” • The President also praised the survivors for their spirit of forgiveness, saying, “Today all we can do is apologize but you have the power. Only you have the power to forgive. Your presence here shows us that you have shown a better path than your government did so long ago.”

10. What makes for good and bad apologies? • Good apologies • Acknowledgment of responsibility and allowing refusal of apology • Sincere remorse • May or may not include explanations or promises to change • Bad apologies • “Apologia” • Blaming victim, minimizing the harm, or deflecting the apology to the wrong party • Only expressing sorrow for suffering Adapted from Lazare, On Apology

11. A Family’s Experience at a Boston Hospital • Son died during hospitalization for seizures • What do families remember? • (Audio excerpt)

12. Conclusion: The Pitfalls of Apology • Can doctors and other health providers be taught to disclose and apologize effectively? • One patient’s final worry (audio)