9780763783617

Medical Errors And Medical Narcissism

by
  • ISBN13:

    9780763783617

  • ISBN10:

    0763783617

  • Edition: 1st
  • Format: Hardcover
  • Copyright: 2004-12-15
  • Publisher: Jones & Bartlett
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Summary

Medical Errors and Medical Narcissism examines the concept of medical narcissism and how error disclosure to patients and families is often compromised by the health professionalís need to preserve his or her self-esteem at the cost of honoring the patientís right to the unvarnished truth about what has happened. This groundbreaking book explores common psychological reactions of healthcare professionals to the commission of a serious harm-causing error and the variety of obstacles that can compromise ethically sound, truthful disclosure.

Table of Contents

Dedication vii
Preface ix
Chapter 1 Error 1(18)
Introduction
1(1)
To Err Is Human
1(3)
Defining Medical Error: Prominent But Poor Definitions
4(1)
Defining Medical Error: A Better Definition
5(2)
Performance Failures
7(1)
Error Inevitability
8(1)
The Systemic Nature of Medical Error
9(2)
Systemic Defenses or the Lack Thereof
11(1)
An Absence of System Checks
12(1)
Applications to Disclosing Error
13(2)
Conclusion
15(4)
Chapter 2 Rationalization 19(28)
JOHN BANJA and GRENA PORTO
Introduction
19(1)
The Emotional Response to Medical Error
19(2)
What Professionals Are Advised About Communicating Error
21(5)
How Do Professionals Actually Communicate Error?
26(4)
Rationalizing the Concealment of Medical Error: Two Explanatory Models
30(3)
How to Rationalize
33(4)
Application of the Selective Attention Model to Concealing Medical Error
37(3)
Conclusion: Is Rationalization Conscious or Not?
40(7)
Chapter 3 Narcissism 47(40)
Introduction
47(2)
Healthy and Pathological Narcissism
49(6)
The "Medical Narcissist"
55(6)
Making the Narcissist
61(7)
Three Characteristics of Medical Narcissists and Their Applications to Medical Error
68(11)
Conclusion
79(8)
Chapter 4 SCRAM: Case Study 87(16)
Introduction
87(1)
The Case
88(8)
Minimization/Maximization
96(3)
Medical Narcissism
99(1)
A Final Point on Systemic Error
100(3)
Chapter 5 Forgiveness 103(16)
Introduction
103(6)
The Significance of Forgiveness
109(2)
Narcissistic Barriers to Requesting or Bestowing Forgiveness
111(2)
The Trajectory of Forgiveness
113(2)
Justice and Forgiveness
115(1)
Conclusion
116(3)
Chapter 6 Remedies 119(54)
Introduction
119(1)
Section 1 Tort Reform
120(12)
The Malpractice Crisis
120(5)
Enterprise Liability and Medical Error Disclosure
125(3)
No-Fault
128(1)
Two No-Fault Systems
129(1)
No-Fault and Errors
130(2)
Section 2 The Blameless and Nonpunitive Environment
132(18)
Introduction
132(2)
Understanding and Assessing Responsibility
134(2)
Blame
136(1)
Blaming: Some Preliminary Considerations
137(3)
Errors and Process Violations
140(3)
Assessing the Degree of Blamability for Process Violations
143(1)
Reckless Errors
144(3)
Ex Ante Versus Post Hoc Perspectives on Error Evaluation
147(1)
Evaluating the Error Evaluators
148(1)
Blameless and Nonpunitive Environments and the Disclosure of Error
149(1)
Section 3 Mindfulness
150(14)
"Teaching" Ethics
150(2)
Other Regard/Empathy Revisited
152(10)
Managing Resistance to Error Disclosure
162(1)
Managing Rationalizations of Error
163(1)
Conclusion
164(9)
Chapter 7 The Empathic Disclosure of Medical Error 173(20)
JOHN BANJA and GERI AMORI
Introduction
173(1)
Part I The Empathic Model
174(5)
Part II How to Disclose
179(7)
Initial Considerations
179(2)
Talking and Listening
181(5)
Conclusion
186(7)
Chapter 8 Beyond Errors-Beyond Narcissism 193(12)
The Narcissistically Cohesive Self
194(2)
Longings
196(1)
The Healer
197(3)
Errors and Humility
200(2)
The Narcissus
202(3)
Appendix 1 Error Rationalization and the Somatically marking Brain 205(10)
Introduction
205(1)
Emotional Ethics
205(3)
Rationalizations as Salienced Representations
208(3)
Limitations of the SMH for the Explanation of Moral Rationalization
211(4)
Appendix 2 Becoming a Narcissist 215(10)
Introduction
215(1)
The Myth of Narcissus
215(2)
A Healthy Regard for Otherness
217(1)
The Pathological Narcissist
218(3)
The Sadomasochistic Narcissist
221(1)
Conclusion
221(4)
Index 225

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