The Epidemic of 'Professional Shaming'

The Epidemic of 'Professional Shaming'

Hi, I'm Brandon.

I like to joke around when I'm writing about fun topics like Oncology or Antibiotics

But today I'd like to talk to you about something serious.

I'm talking, of course, about professional shaming.

As you'll see in my rant below (consider that your forewarning), I see professional shaming as a big wedge between practitioners in health care. It creates separation between nurses, pharmacists, doctors, dentists, and everyone in between. 

<Steps onto soap box>

I believe that everyone (myself included) participates in professional shaming. And I believe that this has a negative impact on health care. 

So what exactly is Professional shaming?

Professional Shaming [pro-fesh-uh-nl] [shey-ming]
(verb)
1. The act of deriding or belittling other healthcare professionals for a perceived lack in knowledge or questionable clinical decision

Put another way, it's whenever you make fun of an MD for doubling the dose of warfarin when the INR hasn't budged on Day 2...

It's calling the NP an idiot for starting Vanc/Zosyn on every ED patient with a rash... 

It's laughing when the RN asks for help programming her pump because you sent her a highly concentrated bag of Levophed and she wants to make sure she gets the drip rate right... 

It's lighting up social media with complaints about the PA who still hasn't learned that hydrocodone is now a CII...

We even do it to ourselves. We talk about people we graduated with and say "Man if I EVER walk into a pharmacy and they're the pharmacist...I'm turning around."

The wall in your pharmacy...after I walked in and saw you were the pharmacist. (Image)

The wall in your pharmacy...after I walked in and saw you were the pharmacist. (Image)

That is Professional Shaming.

And we all do it. 

But what does it accomplish?

It lets you vent some, sure. It might add to the camaraderie between you and your coworkers. And you get to feel a small dopamine rush for showing your supremacy.

"Look how smart I am! I'm REALLY smart!"

But then what? 

Does it prevent the same error from happening again? Does it educate anyone? Does it improve outcomes? Does a feeling of self-superiority make you a better pharmacist?

Is it "worth it?"

I'll let you answer that for your self. But from where I'm sitting, the answer is a pretty clear "No."

Look. I'm guilty of professional shaming. I do it all the time. This rant is as much for me as it is for you. 

One time my head nearly split in half (literally) when I saw that, over the course of a weekend a PA:

  1. Admitted a patient with a diabetic foot ulcer (with pathology confirmed osteomyelitis) and started cefazolin + vancomycin
  2. Did not take any cultures (wound or blood)
  3. Discharged the patient a day later with a 10 day course of oral clindamycin

Sweet holy hell was I ever PA-shaming that day. You can't "un-say" some of the things I said...

But why? The problem isn't a "PA" problem. It was one individual making a questionable clinical decision (or perhaps a series of questionable clinical decisions...).

I've made plenty of those in my professional career. And I'm just getting started. 

Me. At work. Every day. Image

Me. At work. Every day. Image

Here's my point...

No matter what your profession, all of us in health care have the same ultimate goal. That is to provide outstanding patient care. That's why we're all in this. 

You and I are part of the health care team. The word "team" is important here. It implies that we each contribute something different. 

If we made a football team of only quarterbacks, they wouldn't be very good. Same story if we made a baseball team with only pitchers.

But if you bring together different people with different specialties...

Add a catcher. A short stop. Maybe a center fielder...

Trying to see how many Arrested Development references I can fit into a single post. (Image)

Trying to see how many Arrested Development references I can fit into a single post. (Image)

Now you're building something. On a sports team, each player has a role and responsibility. But they all identify themselves as part of the team. No one says "I'm a first baseman." They say "I'm a first baseman for The Orioles." 

For some reason, we don't see it that way in health care. We identify ourselves within our profession...but we don't identify ourselves as part of the larger health care team.

Put another way, we see ourselves as "pharmacists," or "nurses," or "doctors," but we don't see ourselves as part of a whole group that "makes sick people feel better."

It would be like if the linebackers on a football team only practiced their position drills and didn't come together with the full team. On game day the end result would be an uncoordinated mess.

It'd probably look something like this.

No matter where you work in patient care, you contribute a specialized skill set that improves outcomes. And that's a good thing... 

I'm pretty confident with my ability to assess appropriate drug therapy...but don't bring me a CT of the abdomen and expect me to read it. Don't ask me to place a PICC line. I have no idea how to diagnose ascites and I've never even administered an IV medication.

Our different professions exist for a reason. When we all work together, the patient wins, and so do we. 

 

The problem with professional shaming

Since the history of civilization, groups of people naturally sort themselves into "us" and "them." This is normal, and it makes sense in terms of evolution. So it's not crazy to see us identifying more with our profession instead of health care at large.

But professional shaming takes that division and makes it larger. It seems innocent enough. You're just having a laugh with your coworkers. You're letting off some steam. Your work environment is high stress so you welcome anything that will give you a laugh to help you get through.

And then things go to social media. And it hits millions of other health care professionals. Patients see it too...and they start to trust us all a little less. 

These memes go viral and spread like crazy. You've probably seen a bunch. Here are just a few from some quick google searches. 

These are just a few of thousands. And they don't even touch the number of memes directed against patients. There's a lot more of those. 

And again, they all seem innocent enough. But even if only on a subconscious level, they are contributing to a sort of 'stereotyping' that we all do with other health care professionals. 

 

The solution?

Unfortunately, this isn't one of those articles that has a clear "answer." I'm sort of in the weeds too on this. How do you stop a very normal and natural human response? It requires a sort of meta-cognition to see the forest for the trees.

I think it starts with awareness. 

And then you add perspective. If you know what your colleagues from other areas of health care go through, you are less likely to get all "judgey" on them every time you know something they don't know.

As an example...

For several years, I have been an Adjunct Assistant Professor teaching an online pharmacology class to NPs. The class is a semester long (14 weeks). My pharmacology class is the only drug-based class these future prescribers have.

We go over every class of antibiotics in 2 hours.

There's a lecture called "CNS" where we cover everything from depression to Parkinson's to alzheimer's to MS to bipolar. 

They have other video/reading assignments throughout the week before our live session where we bring it all together. But to a pharmacist this curriculum is crazy. We spent almost the entirety of 4 years of pharmacy school going through what these NPs get in 14 weeks.

And that's not a bad thing. We're pharmacists. They're NPs. We have different areas of specialty. On top of that, I learn something new about medication from my students every single week. These people know their stuff.

Try to keep that in mind when you're about to go off on your next rant.  

The other thing you can do is to spend time with other health care professionals. When you're in school, see if you can spend even a few hours (if not a full day) shadowing a nurse, PA, surgeon, whatever. 

Seeing how much they know (and what they go through on a daily basis) will really help you understand their perspective. And make you less judgmental when they want to transition a patient with pneumonia growing Pseudomonas to ertapenem because it's once daily.   

Next, do stuff outside of work with each other. Go to happy hours. Get to know other health care workers as people. 

Finally, when you see a meme making fun of someone in the trenches with you, don't share it. When you feel the urge to go on a rant and shame the surgery team for another shitty med rec, don't. 

Only You can prevent professional shaming. Image

Only You can prevent professional shaming. Image

Let's put an end to Professional Shaming. 

<Steps down from soapbox>

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