THE WEIGHT of SHAME
Physician suicide rates are significantly higher than those in the general population. Why? As physicians, many of us measure our self-worth through our performance as a doctor. We expect ourselves to be infallible, and that is just not possible. To be human is to err, and so we start off behind the eight-ball basing our self-worth on a lie. Thus, when we make an error, even if a minor one, our sense of worth takes a big hit. And if the mistake is one that leads to any degree of morbidity, or even worse, mortality, we are crushed under the weight of shame. Typically, when in the throes of shame, we isolate ourselves. We fear being seen less-than and criticized by our peers, so we hide what we are going through and pretend everything is alright. Many of us even keep this burden from our loved ones further disconnecting and falling deeper into self-loathing. It is in this suffocating place of shame that many physicians contemplate suicide. Thus, to address suicide, we must look at shame and its effects on the hearts and minds of physicians.
The official Mariam-Webster definition of shame is a painful emotion caused by consciousness of guilt, shortcoming, or impropriety. Like any other difficult or negative emotion, shame serves a purpose. It alerts us to the fact that we must pay attention to something, that perhaps in the future we can respond differently to a situation, or that there might be a better way. However, perseverating on the destructive and painful thoughts that typically accompany shame does not serve anyone. In fact, remaining in that place of self-degradation robs us of our ability to learn, grow, and move forward. This decreases our ability to think with clarity and discernment only further increasing the likelihood of making errors.
So how do we even begin to address the shame that can lay heavily on physicians? Shame, and all that comes with it, can only grow into an overwhelming force when it remains in darkness.
Therefore, we must shed light into the shadows. First, we must acknowledge that shame is an emotion that we contend with, probably more than others. We need to name it when it is present, understand why it is there, and learn how to let go of it. This can be accomplished by committing to a self-reflection and mental-fitness growth practice. As physicians, we need to learn how to bring empathy and unconditional love to ourselves. This is difficult. We chose this profession because we want to make the lives of others better, but we fail to recognize that we cannot do that if we can’t first give ourselves the love and compassion that we deserve. This is the internal work that must be done, remembering that all sustainable change needs to start from within. We next need to begin having open, non-judgmental discussions with ourselves and others that focus on methods of improvement and not blame. This can be something as simple as asking questions empathetically when attending an M&M conference, or voicing compassion for the clinicians involved. And finally, we must be willing to step up and step in when we see or hear a colleague being diminished for committing an error. We need to stand together and show each other that we are here for one another, that we understand, and that it’s okay to be human.
As physicians, we are uniquely capable of creating a culture where medical errors are reviewed with true empathy and compassion for ALL involved. Only WE fully comprehend the responsibility and deep suffering we experience when we believe we have failed. So, I am calling you all to action. Open the windows and let the light in. The next time you make an error, share it with a colleague. Let her know how you’re feeling. Instead of repeatedly playing out the scene in your head, talk it out with her. It is likely that she will be able to offer some clarity, a different perspective, and a compassionate heart. And the gift to your colleague is that the next time she finds herself in a similar situation, she will be less hard on herself and either find you or another to share her struggles with. It is in this way, step-by-step, we will create culture change, bring more compassion to our profession, and begin to mitigate the forces that lead to physician suicide.
Be empathetic when encountering a mistake? That’s a big ask of a culture that tries to inply anyone lesser then them on some kind of imagined heirarchy is making mistakes when they aren’t. My experience as a generalist calling docctors I don’t know is they will tell me I’m wrong, but time usually proves me right. Being known in the medical community precludes that.
A great deal of this may be that too many physicians feel trapped. The debt, bills, family obligations, etc. are a sad backdrop when one realizes this job simply isn’t enjoyable, that the rewards are nowhere near the costs, and one is too far along to do something more meaningful or simply more enjoyable, while the clock keeps ticking louder.
In our American culture in general, there is no support for changing this culture permeated with contempt, suspicion, and the antisocial willingness towards cruelty towards each other, in all manner of places and settings. Can we create “culture change, bring more compassion to our profession, and begin to mitigate the forces that lead to physician suicide.”? We will know when a more sensationalized method of suicide, the American Public Mass Homicide which frequently ends with the death of the perpetrator, decreases. I find it relevant that most American public mass homicides take place at the site of humiliation and shame of the perpetrator, from Columbine to the many centers of “education,” the workplaces and even the churches. If the wrath of the suiciding person is directed tidily towards themself as the hated object, a quiet suicide; but when it is directed, often accurately, towards perpetrators of humiliation, we see a factor in the cause of mass shootings. Control of a population in fear was well-orchestrated by Stalin. The fostering of resentment and the welcome ear that authorities have towards “snitches” is a marvelous control mechanism. You, there – how do you know that no disgruntled person is snitching on YOU? And only psychopaths can bear up under unjust accusation; those with conscience will enervate and weaken themselves with shame.
I do not want to chatter on, but I was recently scolded by the “authorities” at work for receiving a complaint from a patient whom I had seen for several years. He had recently “seen the light” and decided that he had neither hypertension nor diabetes, and could exercise his way to good health. When I saw him, his BP was 200/120 and A1C was 9.5%, and he had lost about 20% of his BMI due to diabetic cachexia.
I did not shame him or scold him, or attack his bogus fixation on his rejection of these diseases. I merely told him that in my opinion, I would not meet him again, as he was in significant immediate danger of death. That enraged him, and he complained to the Authorities, who insist that I apologize to him for being such a Doctor Downer.
That sort of blow against the doctor, for telling a seriously ill patient that he could die, is the sort of bewildering disconnect which leaves moral wounds. I am old enough to stay in the balance of my sadness that my patient is dying, due to misunderstanding. I am merely the watcher at the gate. But who among us can take such blows when they are 30 years old and in the midst of life’s turmoil? What resilience do we have, or lack, at the moment of trial?
Tell that to the new “woke” academics who are more than happy to shill for the plaintiff attorneys. I had one that testified complications should never happen.
A malpractice trial treats the physician worse than criminals get treated these days.