A peppermint candy was all I needed. Whenever I cried after making a mistake in my spelling test in first grade, my teacher, dear Madame Carty, would always give me a peppermint to soothe my feelings. I didn’t know it then, but those feelings were from shame, shame that I was not perfect, that perhaps I was even stupid.
Years later, I was married to a man who believed that all mistakes could be avoided with careful planning. He shamed me into believing that any mistakes I made were the result of laziness, inattention or stupidity, and I had no candied respite from the shame I felt so deeply.
If only a peppermint candy was all we ever needed to sweeten the bitter taste of shame after a mistake. Instead, we grapple with our self-worth, question our abilities, and disregard our true value.
It was my life experience and predisposition to the emotion of shame that led me to pursue a career in patient safety then doctoral research on the emotional impact of shame on healthcare workers after a medical error. Through this work, I began to understand the power of shame in healthcare, especially when the medical error causes physical harm. Physicians, nurses and allied healthcare workers told me stories of medical errors that had happened years and even decades before, stories that still haunted them and unearthed shame, guilt and grief every time they retold them. A nurse who had been traumatized by a harmful mistake she made 20 years prior dissected shame as follows:
“When you look at the word shame, first of all it’s “sshhh” meaning I’ve got a secret, because most of us don’t want to talk about it …we’re already exposed, we’ve already put ourselves out there and exposed ourselves for something that we were never meant to be …we weren’t meant to be careless, we weren’t meant to be untrustworthy, we weren’t meant to be stupid, and yet we’ve just done that … so it’s all you want to do is say “shhh, don’t tell anyone, don’t tell anybody that I’m all those things.
“The end of the word shame is “me”– it’s all about me and who I am, and who I suddenly am NOT… I thought I was a competent nurse, I thought I was going to protect this person, and guess what, I didn’t do that…because it’s now not shushed, it’s all out there, and I’m totally exposed for everyone to see…
“The other part of shame is the first part of the word, S-H-A-M is sham… you’ve just seen that I’m a sham…and it’s a very isolating thing, and because it’s about identity and because it’s now no longer shushed, now I get to see in your eyes what you think about me… and so everything you say to me, everything that I see in your eyes just reinforces already that I am not a good nurse, I’m not the protector.”
After hearing many similar stories from healthcare workers, I was driven to explore how to help healthcare workers recover from these shame experiences. I was also in touch with members of Patients for Patient Safety Canada (PFPSC, the Canadian arm of the World Healthcare Organization Patients for Patient Safety) who were traumatized by unexpected medical harm. It was through this connection that I heard the story of a woman whose mother died as the result of a medication error. The daughter met informally with the pharmacist to talk about their personal experiences; he was able to apologize and explain how deeply affected he was by the incident, and she was able to tell her story to someone who cared enough to listen and grieve with her. Both maintained that the meeting was the catalyst for them to begin to heal, as explained by the daughter:
“We realized that both of us had been on a journey of grief, shame, and fear. But we had been kept apart from each other by a healthcare system that did not yet understand the importance of a restorative approach to healing after harm. Bringing us together made healing so much easier.”
Healing together: could it work for others? I conducted a study to find out. What I heard from patients was that, despite the trauma they endured, many felt empathy towards the healthcare workers involved in the medical error causing harm. Patients understood that healthcare workers did not intend to cause harm and they showed a deep understanding of the emotional trauma a healthcare worker might experience. At the same time, healthcare workers were also empathetic towards the patients, expressing that they wanted to treat patients in the same way they would want to be treated themselves—with honesty and connecting as one human being to another. Empathy was happening both ways, but the irony was that many did not recognise that the other was also empathetic towards them. Helping both parties understand this mutual empathy might help bridge the gap between them and create a safe space for a mutually healing conversation. For this to work, there are many hurdles and barriers to overcome – not the least of which are fear of litigation, aversion to conflict and overwhelming shame for healthcare workers, and distrust, anger and trauma for the patients and families. But a mutual healing opportunity may represent an emotionally healthy step towards healthcare workers overcoming the shame they so often feel after a medical error. Hearing about and understanding this shame would also greatly benefit the patient or their family, allowing them to walk away knowing the experience had a great impact on the healthcare workers and was not one they would soon forget.
I do not eat peppermints anymore. They are mostly sugar after all, and the sweetness lasts only a few moments. Now when I feel shame about a mistake – and I do make mistakes worthy of shame – I don’t sugar coat my feelings but recognize them for what they are: a natural reaction to an unexpected stark reminder that I am an imperfect, vulnerable and caring person. And that is a sweet feeling.
Dr. Diane Aubin, PhD (Educational Psychology), Healthcare Consultant, Diane Aubin Consulting
 Davies JM, Steinke C, Flemons WW. Fatal solution: how a healthcare system used tragedy to transform itself and redefine just culture. New York, NY: Routledge, 2022, p. 236.
21st November 2023