We are shame-full

A couple of weeks ago I was out for one of my routine dinner dates with Gia Lewis and Tom Varghese; dinners like these are something I highly recommend as a way to stay connected to your core values with people who share them.  And, of course, we manage to resolve plenty of the world’s issues and discover that we’re all wickedly funny.  I also walk away from these dinners learning at least one new thing.

Other than encouraging you to hang out with people you adore (because we ALL need more of that!), there really is a point to the story about our recent dinner. We got into a fairly intense discussion of surgical culture and the fact that moving the needle to be more inclusive and kinder is just plain hard. Sure, there are all of those things that we learned in kindergarten (credit to Mind Shift for this great infographic).

But somehow in the moment of being an adult and trying to get ahead, we lose sight of so many of those things. Or we’re taught that they aren’t actually cultural expectations where we are, and slowly we become less connected to the value of not hitting people (perhaps not physically, but you get the idea) or telling people we are sorry. Most importantly, we transition from the idea of feeling guilty (“I did a bad thing”) to feeling shame (“I am a bad thing”). As Gia astutely stated, in surgery we are cultivators of artisan shame: “We water it, we cultivate it, we sell it at the Farmer’s Market on Saturday morning.” (See, I told you we’re funny, even when we’re speaking painful truth.) And, of course, shame is highly correlated with maladaptive behaviors and burnout.

So what is a surgeon to do to help herself and her colleagues function in a less shame-full world? Besides warm cookies and cold milk, how can we help change things? Brené Brown has some ideas, of course, since she’s made a career of researching shame- and I’ve had a couple of interesting email exchanges with her about shame and surgical culture.

Brené on surgical checklists: “When they teach those folks how to suture, they also teach them how to stitch their sense of self-worth to being all-powerful, and all-powerful folks don’t need checklists.”

Yep.  This is us.  This is who we are. And watching her TED talk again left me with so very many questions if we’re going to do this and foster a place that supports creativity and innovation…

How do we help each other be less afraid to fail?

How do we help each other to conquer impostor syndrome?

How do we help each other be “enough”?

How do we apologize to each other, to our patients, to their families when things go wrong and we make those mistakes?

How do we help our female colleagues understand that we do NOT have to do it all?

How do we help our male colleagues understand that it’s okay to be weak, it’s okay to fall down?

How do we get rid of secrecy, silence, and judgment that allow shame to flourish?

How do we help each other to show up being our best- and imperfect- selves?

Perhaps the secret starts exactly where we were on that Friday night- hanging out with people we adore.  I want to believe it’s a first step.



3 thoughts on “We are shame-full

  1. Wow. So very true, jarring and powerful. I too was a cultivator of artisan shame for nine years during surgical training and then into practice. It really was not until I became profoundly ill that I had the FORTUNE to look at my world and the profound dysfunction of my professional and personal life.
    Cheers to you for articulating our experience and culture, so very artfully and without judgement (so to not further bruise our already tattered egos).
    Well done, Doc, and thank you

    1. Thank you for reading, and thank you for being part of the change we so desperately need.

  2. The challenge of any attempt to communicate is the imperfect tools we are forced to use. It may be we have transcended from stone, to parchment, to a glowing screen in our palm, but we are still constrained by imperfect words and minds. Your words speak to my heart and pluck it’s strings…but my reason has yet an pruritic patch. The sublime Saturday would include both truth and grace. The truth can be painful, but it does not make it wrong. It can be wielded as a weapon, but it does not make it a lie. Similarly, dining with those we love will provide full measure of grace- but sometimes fall short of sharing a hard truth. I wonder if sometimes a “Brad” and a “Polly” must dine together for a start