Medical Errors And Medical Narcissism

by Banja, John

• ISBN13: 9780763783617
• ISBN10: 0763783617
• Format: Hardcover
• Copyright: 2004-12-27
• Publisher: Jones & Bartlett Learning

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 professional’s need to preserve his or her self-esteem at the cost of honoring the patient’s 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