Many serious medical errors result from violations of recognized standards of practice. Over time, even egregious violations of standards of practice may become "normalized" in healthcare delivery systems. This article describes what leads to this normalization and explains why flagrant practice deviations can persist for years, despite the importance of the standards at issue. This article also provides recommendations to aid healthcare organizations in identifying and managing unsafe practice deviations before they become normalized and pose genuine risks to patient safety, quality care, and employee morale.

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This project used the ACGME "Toolbox of Assessment Methods" to evaluate the competency of emergency medicine trainees to perform an effective and empathic death disclosure. The finding of inconsistent competency assessments by resident self-evaluators compared with those assessments made by faculty and standardized patients have important implications in future curricular design.

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Specialists in pain medicine commonly experience psychological assaults on their self-esteem, especially from patients who seem unreasonably demanding, overly critical, or threatening. This article will discuss how these challenges can trigger a professional's self-protective and defensive coping mechanisms that, in turn, can provoke decidedly unempathic responses. Situations that compromise empathy, however, can be particularly worrisome in health delivery practices like pain medicine that are highly relational and that seek to use relationships therapeutically. The article will therefore conclude with two sets of strategies that might be useful in managing these uncomfortable situations more empathically. The first set will focus on certain pragmatics of empathy skill development. The second will discuss the Eastern notion of "bare attention" as an ideal form of empathic engagement that can also counteract an unhealthy degree of defensiveness when self-esteem is threatened.

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