Healthcare workers are primed to feel inadequate about their mistakes, their own mental or physical illness or their lack of ability to heal some patients, according to a perspective essay published Oct. 19 in The Lancet.
The feeling of shame is natural, but it can drive disconnection, psychological distress, impaired empathy and disengagement.
Clinicians often link their identity and self-esteem to achievement, reputation and belonging — which are tied to patient care. When poor clinical outcomes, missed targets or complaints from patients and staff occur, shame abounds.
"The work of healthcare is infused with risk for shame," said essay authors Luna Dolezal, PhD, and Will Bynum, MD.
Drs. Dolezal and Bynum work at the University of Exeter in England and Durham, N.C.-based Duke Health, respectively. They are co-directors of The Shame Lab and co-lead the Shame and Medicine Project, which is based at both universities.
Here are four notes from the article:
1. Patient shame is usually connected with stigmatized experiences such as mental illness, obesity, sexually transmitted infections or substance use. To avoid shame, patients will withhold details from their healthcare provider, avoid treatment or discontinue care.
2. Among clinicians, the avoidance of shame appears in withholding disclosure of a near miss or medical error, not speaking up about patient safety issues, engaging in substance use or responding with anger. All these reactions undermine safe patient care and team functionality.
3. Shame is healthy and needed, but healthcare organizations can deploy shame competence throughout their business. The authors define shame competence as "a set of skills, principles and practices that facilitate constructive engagement with shame."
4. The five pillars of this competence is maintaining awareness of shame, recognizing shame and its complex manifestations, avoiding inducing the feeling onto others, providing proactive support and transforming organizations to be shame competent.
"Becoming a shame competent organization entails critically reviewing existing policies (e.g., codes of conduct), practices (e.g., morbidity and mortality conferences) and healthcare spaces (e.g., the layout of a waiting room) for their potential to cause shame."