Vulnerability, Shame and Health Care

Brene Brown. By now, you’ve probably heard her name or heard about one of her TED Talks (see below). Dr. Brown has researched shame and vulnerability and how it impacts individuals’ lives. In her research regarding shame, she has tried to learn how individuals can overcome shame and why some suffer so much more than others. Regarding vulnerability, she has sought to learn how and why some people are much more comfortable with being vulnerable with others and how it allows those individuals to live much fuller lives.

So, what does all of this have to do with health care?! A lot. Brene Brown could be great reading for both providers and patients.

Regarding Patients
Because many individuals visit their health care provider in times of crisis, often with embarrassing symptoms and/or as a result of poor life choices, and often with little to no established doctor-patient relationship, many patients show up feeling shameful and vulnerable. And, in order for providers to do their job well, they often have to get additional sensitive personal information out of patients. Thus, a good provider should be able to put a patient at ease, minimize their sense of shame, and allow them to feel vulnerable. Thus, health care workers need to consciously provide a safe, nonjudgmental space for their patients. (I would love for Dr. Brown to research this –how can providers help reduce feelings of shame and vulnerability in patients?)

But, what about health care providers?! Do they ever feel vulnerable or shameful? Probably not, you think. I disagree.

Regarding Health Care Providers
Three situations immediately come to mind:

1. How about when, as a health care provider, you don’t know the answer to something? And, you have to say, “I don’t know?” I’m guessing that makes you feel pretty vulnerable. After all, physicians are taught to always know the answer and make a diagnosis.

2. How about when a patient you are treating is going to die? Often, the transition from treatment-and-cure to talk of end-of-life care can leave physicians feeling vulnerable (and sometimes shameful?) for many reasons –feelings of defeat, second-guessing treatment options, anxiety about breaking such news to patients and family and/or feelings of sadness due to the loss of a patient. They can all leave a provider feeling very vulnerable.

3. How about when you make an error, or worse, are named in a med mal lawsuit? Many studies have shown how distressing such events are for health care providers and how they often feel shame, isolated from their colleagues and often second-guess their skills as a physician. And, many providers don’t just suffer “manageable” distress, suicidal thoughts among physicians have been found to be significantly higher than the general population. One study showed that surgeons’ suicidal thoughts are up to 3 times higher than that of the general public. According to the article, “…16.2% of surgeons who reported a recent major error reported suicidal ideation compared with 5.4% of those who did not report an error.” Clearly, there must be shame and vulnerability at play here.

All of that said, one of Dr. Brown’s big messages is to embrace vulnerability. Feeling vulnerable doesn’t have to be a negative thing. According to her, we can learn to embrace vulnerability and allow it to make richer, more powerful connections with others. To learn how to do this, read her books.

Watch Dr. Brown’s funny and insightful talk below.