Shame and the medical profession

medical-1006787_960_720Shame, an emotion that’s too uncomfortable for most people to even recognize, let alone process. The following makes so much sense.

Shame: A Major Reason Why Most Medical Doctors Don’t Change Their Views
    
by Frank Davidoff – from http://www.health-care-reform.net/shame.htm

“… Doctors may, in fact, be particularly vulnerable to shame, since they are self-selected for perfectionism when they choose to enter the profession.   Moreover, the use of shaming as punishment for shortcomings and “moral errors” committed by medical students and trainees such as lack of sufficient dedication, hard work, and a proper reverence for role obligations probably contributes further to the extreme sensitivity of doctors to shaming.

What are the lessons here for those working to improve the quality and safety of medical care?  Firstly, we should recognize that shame is a powerful force in slowing or preventing improvement and that unless it is confronted and dealt with progress in improvement will be slow.  Secondly, we should also recognize that shame is a fundamental human emotion and not about to go away.  Once these ideas are understood, the work of mitigating and managing shame can flourish.

This work has, of course, been under way for some time.  The move away from “cutting off the tail of the performance curve” that is, getting rid of bad apples towards “shifting the whole curve” as the basic strategy in quality improvement and the recognition that medical error results as much from malfunctioning systems as from incompetent practitioners are important developments in this regard.

They have helped to minimize challenges to the integrity of healthcare workers and support the transformation of medicine from a culture of blame to a culture of safety…”

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