In health care, we are hard wired to do all we can to\nminimize error and avoid failure. The journey of training and practicing\nmedicine rests on the premise of perfection. And yet, perfectionism and shame\nare thought to be the two sides of the same coin. As clinicians, we have the\nprivilege of interacting with people from all sections of society during the\nmost vulnerable times of their lives. It is worth considering why we have such\na hard time being vulnerable ourselves. <\/p>\n\n\n\n
One evening, at dinner, a friend who is a banker brought\nup the issue of medical errors. How it is unacceptable for doctors to mess up.\nShe wanted to know why we don’t score a 100% on every single test, since we are\ndealing with precious human lives. The two doctors at the table, me included,\nburst out laughing. She smiled and asked \u201cI am serious, did you score less when\nit came to the liver, or was it the kidney? Did you choose to skip learning\nabout the uterus or was it the brain!?\u201d We simply couldn\u2019t respond, given the\nabsurdity of the question. However, it did bring up some uncomfortable feelings,\nespecially shame, when I remembered the tests I have failed.<\/p>\n\n\n\n
The next day, I thought about her question more. About\nthe expectations society sets for doctors and the ones we set for ourselves. As\na physician, I do feel like I am expected to be the superhero at times, without\na cape. These unrealistic expectations start to shape the way we behave at work\nand how we view life itself. <\/p>\n\n\n\n
Failing exams made me question if I was good enough to\npractice Medicine. We know that not all good test takers make good clinicians.\nI wish I had responded to my friend by reminding her that clinicians are human\nbeings after all. We try our best and rely on a team and slew of experts to\nhelp us do our jobs. <\/p>\n\n\n\n
To me, shame, guilt, fear and judgement feel like the four pillars that\nperfectionism stands on. The shame culture in medicine is woven thickly into the\nfabric of our profession. We are taught to associate vulnerability with\nweakness, instead of courage. And to never show any chinks in our armor. <\/p>\n\n\n\n
Given the escalating rates of physician suicides and\nburnout, wellness and resilience are the new buzzwords. Wellness committees are\nbecoming a norm in hospitals and training programs. A huge component of\nwellness is developing the ability to be vulnerable and courageous, which is\nteachable. <\/p>\n\n\n\n
Bren\u00e9 Browns research on vulnerability and shame is\ncompelling. It resonates with people globally and is highly applicable in\nhealth care. She defines vulnerability as that which involves uncertainty, risk and emotional exposure.\nAccording to her research, learning to be vulnerable and courageous are\nteachable skills. A skillset that needs to be learnt in Medical School or\nbetter yet, from childhood itself. Learning to clean our teeth and bodies is a\nno brainer. Cleaning our minds and sorting through emotions is equally\nimportant. Yet, most of us are not taught routinely how to do so. <\/p>\n\n\n\n
Being courageous requires us to be vulnerable. In\nMedicine, each day is filled with uncertainty, risk, emotional exposure and new\ndiscoveries. The nature of our profession demands courage, confidence and\nvulnerability on a daily basis. And that is a beautiful thing. Shame, however,\nis counterproductive and we need to learn more about it.<\/p>\n\n\n\n
The way we handle shame impacts the way we treat each\nother and communicate with patients. It colors our responses to medical errors\nand affects the way we teach and treat our trainees. We are trained to\nrecognize discomfort in patients. We are not trained how to recognize our own pain\nor name the emotions we feel. We are not trained to cope effectively with\ndeath, medical errors or malpractice suits. These very issues are what\nperpetuate a toxic culture leading to dropout, burnout and more. We are tested\non our Intelligence Quotient. What about our Emotional Quotient?<\/p>\n\n\n\n
My 31-year-old patient had a sudden and unexpected death\nin the Intensive Care Unit within a few days of his admission. His untimely\ndeath affected everyone involved in his care deeply. In the time that lapsed\nbetween his death and the autopsy report, I had experienced what shaming in\nmedicine involved. Every physician has encountered a similar experience at some\npoint in their careers. It is all too familiar and quite distasteful. <\/p>\n\n\n\n
The safety checks we have today are a result of reported\nerrors. Mistakes can lead to innovation and creativity. Health Care workers\ncome to work wanting to do the right thing. And yet, to err is human. Penalties\nfor errors are heavy in the field of health care. Whether it is losing your\nlicense to practice or facing a malpractice suit. Then there is our own\nconscience we get to face, hoping we did right by every patient, every day. Maybe\nwe can be more graceful in handling the moral injury and shaming that ensue\nwhen mistakes do happen in Medicine.<\/p>\n\n\n\n
When we respect pain and allow ourselves to feel it\nfully, we heal faster. Learning to sort through difficult emotions helps us\ncope in a healthier way. Living with unacknowledged pain can make it easier to\ninflict misery on others or engage in self-destructive behaviors. Learning to\nrecognize shame and dealing with it effectively will make us better clinicians\nand improve our existing culture in Medicine. These transformative skills are\nnow being taught in workshops to employees in Silicon Valley increasingly.<\/p>\n\n\n\n
It is time for Health Care to invest in these skills. It will positively impact the way we learn, work and teach; ultimately improving patient care. We are taught to prioritize patient care above all else. A paradigm shift to focusing on understanding our own inner workings first, will lead to the same goal. Learning to deal with shame is part of self-care in health care. And when clinicians practice self-care, patients receive exceptional care.<\/p>\n\n\n\n