Shame on you. Or perhaps shame on me?

“Vulnerability is the birthplace of innovation, creativity, and change.”

I was introduced to the work of Brené Brown just before the publication of her book The Gifts of Imperfection.  If you haven’t come across her work via Oprah or another major media outlet, Brené has a PhD in social work; her area of emphasis in her work is shame.

Yes, shame.

I Thought it Was Just Me was life-changing reading for me.  It was that big. As I was reading her work on shame and the quest for perfection (and both of their complex relationships with power structures), I saw our medical education system.  I saw so much of surgical education in particular, and could attach names to the pictures of “parents” (senior residents, faculty members) who adhered to the shame and blame paradigm rather than fostering compassion and a healthy sense of guilt.  When my colleague Will Elder was conducting interviews for our work on disruptive surgeon behavior he brought back to me the use of the word “shame” by one of our interviewees, who was describing the educational philosophy ascribed to by disruptive faculty.  On that day I knew we were on to something big.  I still believe that.

Brené describes shame as “the gremlin who says, ah-ah, you’re not good enough.”  Here’s the thing about shame:  it has lots of dirty side-effects. Shame increases dysfunctional coping, be that addiction, violence, eating disorders…things that people do to maintain disconnection from the world around them.  In our profession, shame looks like burnout and impaired physicians, and the perfectionistic tendencies of almost all of us in medicine put us at higher risk than the “average” person.  Our culture and ourselves provide a set-up for us to self-destruct- and the data show that many (too many!) of us do just that.

Since my initial reading of Brené’s work, I’ve committed to trying to change my corner of the surgical world by making it a place where we strive to say, “I made a mistake and I’m going to do better” (guilt) rather than, “I am a mistake and can’t do better.” (shame)  Like any parent or any human, I’m not perfect, and some days I am very, very far from perfect in leading that culture change.  I try to provide a safe place for my trainees, particularly the students, to talk about the “hard stuff” that is inevitably part of medical education.    And, to be completely transparent, I started this blog in hopes that it could be an antidote to shame as colleagues read it and think, “Yeah.  Me too.”  The most rewarding part of my electronic relationship with you, dear reader, over the last year and a half has been how many people have told me they’ve really connected with something that I wrote here.  I have weeks that I suspect my crazy ideas here are more impactful than a great deal of my academic work.  And I believe that my vulnerability here has been the nidus for a tremendous amount of innovation, creativity, and change.

For those curious about Brené Brown’s work, this TED talk is a terrific introduction to her ideas.  And, of course, as a Texan she tells great stories.