July / August 2006
A Role Model, Not Only for Physicians
I took pages and pages of notes at the National Patient Safety Foundation’s Congress held in San Francisco in May, but the page I labeled “Thursday afternoon plenary: Jo Shapiro” is blank. Dr. Shapiro’s presentation was so riveting, I forgot to take notes.
Shapiro is associate director of medical education at Massachusetts General Hospital and Brigham and Women’s Hospital, where she is also a surgeon, and associate professor at Harvard Medical School. The Thursday afternoon plenary, titled “Disclosure and Apology — Stories from Doctors and Patients,” also featured presentations by Drs. Lucian Leape and Georges Peter. Shapiro’s role was to describe the experience of disclosure and apology from the physician’s viewpoint, not in abstract terms, but from her own experience.
Shapiro described one of her patients, who developed an infection following surgery. The infection was caused by a mistake — a recognized, possible complication but a mishap nonetheless — made during surgery. The patient recovered after a period of additional care and recuperation. Shapiro disclosed the mishap directly to the patient, apologized, was sued for malpractice, and prevailed against the charges.
The impact of this story was profound for me and for the Congress audience. It had clearly been a terrible experience, the complexity of which she was able to convey. I came away with tremendous respect for her level of understanding about the experience, her compassion for her patient, and her generosity in sharing a difficult story. Shapiro is an excellent role model for physicians: compassionate, communicative, and accomplished. For that matter, she is a role model of emotional clarity and sophistication for all circumstances.
Some improvements that are being asked of physicians — communicating effectively with patients, openly disclosing errors, apologizing for injuries, confronting colleagues who are disruptive or abusive — require an uncommon level of competence in managing emotional situations. Given the stereotype — egotisical, autocratic, driven — the model now being advocated represents a dramatic change. For most people, success will take resolve, training, and courage. I want to acknowledge the difficulty of accomplishing these improvements, without providing an excuse for avoiding the task. Rather, I find the challenge inspiring. Anyone who develops the emotional knowledge and skills required should find improvement in all enterprises and relationships. It seems to me, beyond being the right thing to do, that the rewards of this learning will more than balance the effort. The emotional competence we’re describing is something for which we all should strive.