The health implications of apologizing after an adverse event.

Australia is working towards a National Open Disclosure Standard in which all adverse incidents are disclosed to patients in all health-care facilities in the country. Among the many good reasons for this approach, one that has not attracted attention is the possibility that disclosure of an adverse incident may moderate its impact on the recovery and general health of patients. In this article, we discuss this perspective with reference to relevant psychological and physiological literature. In the absence of existing research that pursues this specific hypothesis on disclosure and health effects, we called on the extensive evidence that analogous traumatic events can lead to a prolonged state of negative affect and hyperarousal that are deleterious to recovery and health. This state is called 'unforgiveness' by some psychologists. Research suggests that unforgiveness can be alleviated if people who feel aggrieved forgive those they blame for the harm. Forgiving is a complex process, but there is evidence that it is promoted by an apologetic response that incorporates expressions of responsibility, regret and intended action. With the exception of responsibility, these components are part of open disclosure as envisaged in the Standard. We conclude that there is preliminary support from the psychological and physiological literature for further investigation of the hypothesis that disclosure can moderate the recovery and health of patients after an adverse incident, provided that the disclosure incorporates an admission of responsibility.