Shame, patients, and the Internet

“If we can share our story with someone who responds with empathy and understanding, shame can’t survive.”- Brené Brown

Last week over lunch, a colleague and I were discussing some of the on-line physician groups that are out there.  Some are on-line communities within organizations, others are Facebook groups. While we both acknowledged that some of those groups can be incredibly helpful for building a community around shared experiences in the challenges of our work, she astutely noted something troubling to her, and that I realized had been an intangible quality that had troubled me more than once.

It’s the fact that within that “safe” space there seems to be this more-than-casual practice of patient-shaming (Note: It’s the Internet, people. Nothing is “safe” if someone gets a screen shot.). It’s the discussion the obese patient, or the patient whose lifestyle choices we disagree with, or the patient who keeps turning up in our clinic with injuries from self-harming in a way that judges them.

As physicians we’re known to sometimes do this in person, and it seems to be we’re more likely to do it to women (yes, there’s both anecdote and science supporting that claim).  But the internet, particularly these spaces in which we’re with our own people, provides a whole new area of questions around how we talk about our patients.

I’ve heard the argument that it’s like being in the physician’s lounge to talk about patients in this sort of space. I would argue it’s nothing like that, mostly because we don’t have direct personal relationships with most of the individuals in those communities and you don’t know if someone caught a screen shot of something posted that crossed a line. It would be horrifying to post something, realize later it wasn’t a good idea, go back and take it down, and only have it come back to haunt you later because of the dreaded posterity of the internet.

I get that we’re tired, that many of us are struggling with burnout, and that we need some sort of way to process dealing with patients who challenge us.  I’m not saying that I haven’t (under a cone of silence in a true safe space) expressed frustration with a patient and/ or their family; if you haven’t EVER done that, you’re a better person than most of us in healthcare, and we also want to know where you acquired your collection of perfect patients. What I am saying is that we have an obligation as leaders and as human beings to think carefully about the reprecussions of things we say and things we write. More importantly, even when we’re tired and cranky and just DONE, that’s the time we need most to call on our compassion and remember why we chose this profession in the first place. And, of course, we need to choose our audience very carefully when we really just need to vent- and we need to stay out of judgment when we do.

Before you post that patient story in a community or group, think about how you would feel if you knew that you or someone dear to you were being written about in the way you intend to tell the story.  If the answer is either “not very good” or “I’d be furious”, it’s wise to reconsider your decision. And if you see or hear something that makes you uncomfortable, I would encourage you to let the author know that it does and why. We need to learn from one another, and we need to encourage one another to be our very best selves.

 

4 thoughts on “Shame, patients, and the Internet

  1. Thanks, Amalia, for picking this up and running with it. And for your call to stay in that compassionate, empathetic, and non-judgmental zone. Which I think is most important with the most difficult-to-love patients. In anesthesia, we know so little about our patients, it can be tough to find something to like about them. And science says liking people makes a difference. I love the work of Jeannie Kahwajy in this regard: http://www.lifescienceleader.com/doc/effective-interactions-0001.

    • Amalia Cochran MD says:

      When I taught preschool I would tell my children, “I don’t love your behavior right now, but I do love you.” It seems to me that was a great foundation for what we need to do when we have the patients who challenge us.

  2. John-Nathan Stark says:

    I recently re-learned a great lesson from a career nurse of 30 years. He inspired me in a conversation we were having about how to not have the black-hearted nurse in the E.D. His personal style was to “embrace” the frequent flier. He said that that was how he lasted–in the same place–for as long as he had; kindness and compassion as an act of self-preservation. it seems like a timely and needed conversation to start and have Dr. C. Thank you.

    • Amalia Cochran MD says:

      John-Nathan, if you haven’t read Brené Brown’s work on shame and connection, I’m 100% certain it would resonate with you. I Thought it was just me was a life-changer for me, both for the content and because it encouraged me to pivot to qualitative research.

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