Restorative Conferencing in Health Care
"Now the doctor, by virtue of accepting science so totally, creates a total imbalance, forgetting the art of healing, forgetting the art of engagement, forgetting the art of listening, forgetting the art of caring and ceasing to invest time with the patient. So I believe medicine has lost its human face.” ~ Dr. Bernard Lown
Doctors do not like to be shamed or blamed. Neither do nurses. Nor surgeons. As a matter of fact, any query from a patient to the healthcare provider is received as critique of job performance. Much of this is a result of the disconnect between physicians and their patients. Physician, by the way, is the term I prefer to use over “doctor” since learning the definition variations: per Merriam Webster dictionary a physician “heals” and a doctor “has been awarded a medical license” (Webster, 2005). This is a worthwhile difference to note when seeking quality medical care.
Dr. Bernard Lown described in his book, “The Lost Art of Healing” his inspiration for becoming a physician. Frequent visits by the neighborhood physician to his childhood home in the early 1900’s were a base for his understanding of what it ment to help people in need. He was affected positively by the doctor’s presence in his family home and the resulting personal relationship it developed. He hypothesizes by book’s end how different the medico-legal landscape would appear in post-modern times if the physician and patient/family engaged in kitchen-table conversations (1999). Little did the good doctor know he was describing the last stage of formal conferencing: “Breaking Bread, where conference participants share refreshments and casual, spontaneous conversation at the close of the formal conference.
There are many elements to the formal conference script that would enable physicians and medical care providers an opportunity to handle shame that often accompanies a poor outcome in healthcare delivery. Using Ted Wachtel’s (1999) examples of the importance of conferencing to victims and their loved ones in the school, workplace, and criminal environments we can foresee a similar impact in the medical community.
The conference platform provides an opportunity for patients/families harmed by preventable medical errors to address those who have caused the harm while validating their experiences and subsequent feelings. This offers healing, empathy and understanding toward the complexities and challenges of those whose vocation includes the delivery medical care. However, to bring formal conferencing into the medical community an invested medical provider will have to make a calculated risk. There needs to be some hint of trust and encouragement for physician to move forward out of the current culture of shame and blame into a culture of openness and restoring harms. What will encourage such trust?
Masters (1997) evaluates Braithwaite’s “re-integrative shaming” through his studies in criminology. Re-integrative allows for expressions of disapproval and disappointment from the community while still separating the “deed” from the “doer” (Masters, 1997). It also allows for a ceremonial reacceptance of the offender back into the community. On the flip side, the harmful stigmatizing shame reflects back to the days’ of pilgrims and big red letters placed on an offender’s clothing (Hawthorne, 1850). Such shame only serves as an institutionalized disconnect of the community. It will lead to a subculture of outcasts that will continue to negatively impact themselves and the surrounding community (Masters, 1997).
Doctors identifying blame with shame create a disconnect across the collective medical population. Braithwaite was incontrovertible when he discusses “achievement of the most effective development of conscience, i.e. the moderation of behavior through an internal choice about ‘doing the right thing’ rather than through fear of external punishment, responses to misdemeanors must be very similar across social institutions: school, justice, and criminal (Braithwaite, 1989). Sociologists and Criminologists need to include the healthcare or medical care system in their systems analyzed. By not including them in analysis or recommendations, the medical community continues to work on the fringes of our society and within its own internal set of norms. By definition, that identifies a class of social outcasts with negative influences and consequences (Masters,1997). This is exactly opposite of the intent of young people offer upon entrance to medical training institutions.
The internal struggle of a medically trained individual trying to be a doctor while wanting to be a physician (per above definitions) is maintained through the institution’s improper use of shame and blame. In “The Elephant in the Room: Managing Shame is Important for Improving Healthcare,” Davidoff (2002) references a phenomenon from the 1960’s after the development of a drug (tolbutamide) given to lower blood sugar levels in diabetics was discovered to have an increased causal relationship in the deaths of patients who also developed myocardial infarction (cardiac disease). Instead of accolades and appreciation from the medical community to researchers for this insight, the study was met with resistance and even lawsuits. After several tumultuous years a practitioner during a professional symposium stood up and explained “he simply could not, and would not, accept the findings because admitting to his patients that he was using an unsafe treatment would shame him in their eyes” (Davidoff, 2002). There are a variety of professional and academic articles investigating shame amongst the medical community. The struggle to successfully conquer its inappropriate use is the ability to understand the two types of shame as described by Masters (1997) and Braithwaite (1989). Within Restorative Practice education, training and integration in daily healthcare delivery, this longstanding difficult issue will be minimized to save patients’ lives and providers’ livelihoods.
Restorative Conferencing offers the opportunity for the medical community to re-connect with and understand the intentions and hopes of the constituency its serves. Since the medical community is already keenly aware of the presence of shame it is appropriate to address this quality head-on.
Re-integrative shame allows for the community to openly air its disapproval of behaviors that fall outside of their accepted norms (Masters, 1997). This is a finite process, which provides for concrete gestures of reacceptance to the community (Masters, 1997). The individuals who courageously step forward to care for their communities’ mental, emotional, and physical needs as medical care practitioners need a restorative community to address adverse events, unexpected outcomes, bad outcomes, and negligent care. The communities they serve must demand this life-saving safety tool – restorative conferencing in healthcare.
References:
Braithwaite, J. 1989. Crime, shame, and reintegration. New York: Cambridge University Press. (Chapters 1 and 4-7).
Davidoff, Frank. 2002, Shame: The Elephant in the room: managing medical failure. British Medical Journal.
Hawthorne, Nathaniel. 1850. The scarlet letter. Ticknor & Fields. New York.
Lown, Bernard, MD. 1996. The lost art of healing. Ballantine Books.
Masters, Guy. 1997. Reintegrative shaming in theory and practice. Thinking about feeling in criminology. Lancaster University.
Merriam – Webster, 1997. Merriam-Webster Unabridged Dictionary. Merriam Webster Inc.
Wachtel, Ted. 1997. Real justice. The Piper’s Press.
Doctors do not like to be shamed or blamed. Neither do nurses. Nor surgeons. As a matter of fact, any query from a patient to the healthcare provider is received as critique of job performance. Much of this is a result of the disconnect between physicians and their patients. Physician, by the way, is the term I prefer to use over “doctor” since learning the definition variations: per Merriam Webster dictionary a physician “heals” and a doctor “has been awarded a medical license” (Webster, 2005). This is a worthwhile difference to note when seeking quality medical care.
Dr. Bernard Lown described in his book, “The Lost Art of Healing” his inspiration for becoming a physician. Frequent visits by the neighborhood physician to his childhood home in the early 1900’s were a base for his understanding of what it ment to help people in need. He was affected positively by the doctor’s presence in his family home and the resulting personal relationship it developed. He hypothesizes by book’s end how different the medico-legal landscape would appear in post-modern times if the physician and patient/family engaged in kitchen-table conversations (1999). Little did the good doctor know he was describing the last stage of formal conferencing: “Breaking Bread, where conference participants share refreshments and casual, spontaneous conversation at the close of the formal conference.
There are many elements to the formal conference script that would enable physicians and medical care providers an opportunity to handle shame that often accompanies a poor outcome in healthcare delivery. Using Ted Wachtel’s (1999) examples of the importance of conferencing to victims and their loved ones in the school, workplace, and criminal environments we can foresee a similar impact in the medical community.
The conference platform provides an opportunity for patients/families harmed by preventable medical errors to address those who have caused the harm while validating their experiences and subsequent feelings. This offers healing, empathy and understanding toward the complexities and challenges of those whose vocation includes the delivery medical care. However, to bring formal conferencing into the medical community an invested medical provider will have to make a calculated risk. There needs to be some hint of trust and encouragement for physician to move forward out of the current culture of shame and blame into a culture of openness and restoring harms. What will encourage such trust?
Masters (1997) evaluates Braithwaite’s “re-integrative shaming” through his studies in criminology. Re-integrative allows for expressions of disapproval and disappointment from the community while still separating the “deed” from the “doer” (Masters, 1997). It also allows for a ceremonial reacceptance of the offender back into the community. On the flip side, the harmful stigmatizing shame reflects back to the days’ of pilgrims and big red letters placed on an offender’s clothing (Hawthorne, 1850). Such shame only serves as an institutionalized disconnect of the community. It will lead to a subculture of outcasts that will continue to negatively impact themselves and the surrounding community (Masters, 1997).
Doctors identifying blame with shame create a disconnect across the collective medical population. Braithwaite was incontrovertible when he discusses “achievement of the most effective development of conscience, i.e. the moderation of behavior through an internal choice about ‘doing the right thing’ rather than through fear of external punishment, responses to misdemeanors must be very similar across social institutions: school, justice, and criminal (Braithwaite, 1989). Sociologists and Criminologists need to include the healthcare or medical care system in their systems analyzed. By not including them in analysis or recommendations, the medical community continues to work on the fringes of our society and within its own internal set of norms. By definition, that identifies a class of social outcasts with negative influences and consequences (Masters,1997). This is exactly opposite of the intent of young people offer upon entrance to medical training institutions.
The internal struggle of a medically trained individual trying to be a doctor while wanting to be a physician (per above definitions) is maintained through the institution’s improper use of shame and blame. In “The Elephant in the Room: Managing Shame is Important for Improving Healthcare,” Davidoff (2002) references a phenomenon from the 1960’s after the development of a drug (tolbutamide) given to lower blood sugar levels in diabetics was discovered to have an increased causal relationship in the deaths of patients who also developed myocardial infarction (cardiac disease). Instead of accolades and appreciation from the medical community to researchers for this insight, the study was met with resistance and even lawsuits. After several tumultuous years a practitioner during a professional symposium stood up and explained “he simply could not, and would not, accept the findings because admitting to his patients that he was using an unsafe treatment would shame him in their eyes” (Davidoff, 2002). There are a variety of professional and academic articles investigating shame amongst the medical community. The struggle to successfully conquer its inappropriate use is the ability to understand the two types of shame as described by Masters (1997) and Braithwaite (1989). Within Restorative Practice education, training and integration in daily healthcare delivery, this longstanding difficult issue will be minimized to save patients’ lives and providers’ livelihoods.
Restorative Conferencing offers the opportunity for the medical community to re-connect with and understand the intentions and hopes of the constituency its serves. Since the medical community is already keenly aware of the presence of shame it is appropriate to address this quality head-on.
Re-integrative shame allows for the community to openly air its disapproval of behaviors that fall outside of their accepted norms (Masters, 1997). This is a finite process, which provides for concrete gestures of reacceptance to the community (Masters, 1997). The individuals who courageously step forward to care for their communities’ mental, emotional, and physical needs as medical care practitioners need a restorative community to address adverse events, unexpected outcomes, bad outcomes, and negligent care. The communities they serve must demand this life-saving safety tool – restorative conferencing in healthcare.
References:
Braithwaite, J. 1989. Crime, shame, and reintegration. New York: Cambridge University Press. (Chapters 1 and 4-7).
Davidoff, Frank. 2002, Shame: The Elephant in the room: managing medical failure. British Medical Journal.
Hawthorne, Nathaniel. 1850. The scarlet letter. Ticknor & Fields. New York.
Lown, Bernard, MD. 1996. The lost art of healing. Ballantine Books.
Masters, Guy. 1997. Reintegrative shaming in theory and practice. Thinking about feeling in criminology. Lancaster University.
Merriam – Webster, 1997. Merriam-Webster Unabridged Dictionary. Merriam Webster Inc.
Wachtel, Ted. 1997. Real justice. The Piper’s Press.
Comments
Post a Comment