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