September 20, 2019

Shame and Leaving Medicine

 

Thomas Shahan Flickr

Photo by Thomas Shahan

OK dear readers, put on your headlamps and waders, we’re going into the dark, damp cave of shame.  The cave of shame around leaving medicine.

“Why?” you may ask. “Is this really a problem?”

Yes, it’s a problem I see on a regular basis.  Since I work with many doctors who are dissatisfied with their careers, I witness firsthand how shame traps highly intelligent, dedicated physicians in a no-man’s-land of self-doubt and confusion.

But before we travel too far into the cave, let me define shame.  Shame is the painful emotion caused by a strong sense of embarrassment, unworthiness or disgrace.  In her book, What Doctors Feel, Dr. Danielle Ofri makes the distinction between guilt and shame. “Guilt is usually associated with a particular incident and can dissipate when the issue is resolved.  But shame reflects a failure of one’s entire being.  While guilt often prods a person to make amends, shame induces them to hide.”

Herein lies the problem.  The shame.  The cave.  The hiding.  Paralysis.

If you’re a physician questioning staying in medicine, you’re not just considering the loss of a job, you’re facing the potential loss of your identity, and a concomitant sense of failing.

This heavy identification of one’s self-image with one’s career is present in many occupations, but it’s especially strong in medicine.  Society reinforces this perspective, with the expectation that doctors will “die with their boots on.”  And honestly, who goes through all that training while planning on leaving?  Very, very few.  But things happen along the way and with all the changes in medicine, many doctors are finding themselves burned out, disillusioned, and uncertain about their futures.

Being unhappy as a doctor can bring up all kinds of self-doubts.  “What’s wrong with me?  My partners seem fine.  Am I not cut out for this? Why do I worry so much?  Do I need a different practice setting or is it just me?  What will others think if I leave?  What else am I trained to do?  Did I make a mistake in choosing medicine?  Do I not care enough about patients, do I care too much?” These are not the kinds of thoughts we tend to SHOUT FROM THE ROOFTOP.  No, we hide them.  For a while they can even be hidden from ourselves.

Shame researcher, author and speaker, Dr. Brené Brown says in her TED talk, Listening to Shame, “Shame needs three things to grow: secrecy, silence and judgment.”

We see the secrecy and silence in the reluctance to let anyone know what’s going on.  Judgment comes in in the form of our own internal critic, (the voice in our head) and from others.

These voices are often dominated by shoulds.  You should do this because…. “

You should stay in medicine because:

You don’t want to waste all that training, do you?
You have special skills for helping people, you should use them.
You’re the primary breadwinner and need to make good money.
You took up a slot in medical school and residency.
You have a mountain of debt to pay off.
You don’t want to be a quitter.
Your family sacrificed for you and you’ll disappoint them.
You’ll let your patients and colleagues down.
What else are you qualified to do?
Your identity will be lost.

Making decisions based on a bunch of shoulds may work for a period of time, but these negative motivators are a poor substitute for true desire.  It’s a catch-22 situation.  You’re not happy with your career, but it’s shameful to consider leaving.  You feel trapped

What’s the way out of the trap?

Turn up the headlamps!  Shame cannot survive in the light.  First put the light on yourself and take an honest look at what’s going on.  Without judging your situation, ask yourself what’s working and what’s not.  Find trusted individuals who can listen without an agenda.  Whatever you’re experiencing, others have been in a similar place and can empathize.  Brené Brown instructs in her TED talk, “The two most powerful words when we’re in struggle [with shame] is ‘me too’.”

One of my clients, Dr. Danielle Gerry, courageously shared her story about leaving medicine on my blog.  To this day, I still have physicians telling me they felt her story could have been about them.  There was this sense of “me too.”  I asked Danielle the role shame had in her journey.  With characteristic honesty she responded,

“It was shame that kept me working at a job I detested.  It was shame that made me feel like I deserved to be unhappy.  For other folks, I suppose it is shame that keeps them in bad marriages, shame that keeps them addicted, obese, unhealthy.  Shame is such a destructive force and it is insidious and covert in its mission to destroy lives.

“It was not until I “came out of the closet” so to speak and announced my story for the entire world to see on the Internet that I was able to shed some shame.  I, Danielle Gerry, M.D., did NOT like being a primary care doctor.  [Insert thunderclaps, hail, lightening, my mother’s gasps of disbelief, horror movie soundtrack playing]  In fact, I went to medical school for all the wrong reasons.  [Gasp].

“Fast forward a year or so…  Writing the blog about my reasons for leaving medicine was entirely liberating.  I just could not be ashamed anymore.  My story was bathed in light and I found out that I was NOT alone.  There were other doctors just like me, with similar stories, worries and feelings.  When you cease to hide your shame, when you announce it, wave it like a flag over your head for all to see, you quickly realize that you are not alone.  Shame can only survive in isolation and darkness.  Be your authentic self and you will surely realize that you are in amazing company!”

For Danielle, leaving was the right choice.  For you it may be leaving; it may be staying.  In order to find out what’s best for you, give yourself the space to hear your own inner voice.  Suspend the shoulds, the judgment, and the shame.  In this quiet place you can begin to hear what you really need and want.  No one else can know what this is for you.  No one else gets up each day and lives your life but you.  It’s up to you to trust the wisdom in this voice and where it will lead you.

 

 

 

 

 

Comments

  1. Mary Lou Vaskus says:

    I was a patient of Danielle’s, she was the best doctor I ever had. Not only a good doctor but a good and compassionate person. I really respect that big step she took to be true to herself and I hope she is happy in her new career. I lost my health insurance around the time she left the practice and just got it back, I was trying to see if she was practicing again when I found this article.

    If you should ever talk to her please tell her I as asking about her and that I think she is amazing!!!

    Truly,

    Mary Lou

    • Heather Fork says:

      Thank you Mary Lou for your great comments about Danielle. I have shared with her what you wrote and she is most appreciative. You are very kind and thoughtful to offer your support and well wishes here. Best wishes to you.

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