Home Q&A Unmasking shame in medicine

Unmasking shame in medicine

A podcast series takes on shame in medical culture

March 2023
Credit: Beppe Conti

EMILY SILVERMAN, MD, is having a moment, one that’s been years in the making.

In 2016, she founded The Nocturnists to host clinicians telling live stories about their experiences in medicine. Those events have just gotten larger and gone national.

The Nocturnists collected audio diaries from hundreds of health care workers for two “Stories from a Pandemic” series and donated all the audio to the Library of Congress. Black clinicians working with the Nocturnists created the “Black Voices in Healthcare” series after George Floyd was killed.

Dr. Silverman’s latest series is “Shame in Medicine: The Lost Forest,” a 10-part podcast that debuted last September. The series drew more than 200 clinicians who submitted audio clips that were then organized by themes: being sued, being bullied, making errors, getting sick, failing exams, being a parent, having a broken childhood or a disability or mental illness. One anecdote after another paints a culture that relies heavily on shame and doesn’t tolerate vulnerability. “I wondered,” one doctor in the series says, “if people with imperfect stories had a place in medicine.”

“There is no quick fix.”


Emily Silverman, MD
The Nocturnists

The series—which Dr. Silverman in one podcast calls “a love letter to health care”—has been racking up media awards, and she is part of a panel discussion on the “Shame in Medicine” series at Austin’s South by Southwest festival this March. Dr. Silverman spoke with Today’s Hospitalist.

This series comes out at a time when many clinicians are burned out or angry or both. How does talking about shame help physicians process what they’ve gone through in the pandemic?
Even before covid, we were dealing with a workforce in crisis. Hospitals were starting to think about physician burnout and hiring chief wellness officers to try to figure out a quick fix. But there is no quick fix because it’s such a deep and systemic problem.

When the pandemic struck, it really unmasked things we’ve always felt shame about: becoming sick, being sad or overwhelmed. The pandemic also took out a huge chunk of the workforce, and that revealed the complete lack of redundancy in the staffing model. The pandemic made it clear that it’s actually the system that lacks resilience, not the individuals working in it.

I think that’s led many of us to re-examine what’s been a passive acceptance of things in medicine that don’t work.

Where does that passivity come from?
A lot of us are science nerds who have been acculturated to not rock the boat. Many of us who show up in medicine are the teacher’s-pet type, pretty submissive to authority. We are people who want to please.

There’s also this self-sacrifice piece of the culture where, “I can take more work, I can survive, I saw 24 patients today and I’m so tired, wink, wink.” People are somehow supposed to take pride in that suffering. But that became so unsustainable in the pandemic that we have been forced to become more aware.

The pandemic was like a stress test for the profession that we failed. We have a lot of external work to do with administrators and executives, but a lot has to start internally. I feel that learning about some of the shame we’ve taken on is a necessary first step to reclaim the profession.

What kind of outreach are you doing around this series?
Because our team is so small, we decided to leverage our grassroots community of listeners. This winter, I held what I called the Shame in Medicine Ambassador Webinar—and 80 people showed up on a Zoom call on a weekday night.

Many said they still aren’t sure it is safe to speak up locally about shame. Others thought it would be hard to get institutional buy-in for a formal panel or discussion. While their institution is happy to fund more benign interventions like yoga and meditation, even things like a peer-support group felt threatening.

Credit: Beppe Conti

Some people look at the shame series and think, “This isn’t an issue for me. I just need a lower patient cap or fewer hours or sick leave,” so that’s another initial reaction. Most were organizing informal discussions outside their institution, like one woman who has a book club with her surgery colleagues. They’ll discuss the series instead of a book.

Others have organized grand rounds and have asked me to come. I’ve received a handful of invitations from institutions and have now started touring around the podcast, doing talks and presentations.

How has this informed your own practice?
I stepped away from hospitalist practice in 2022 and now volunteer clinically a couple of weeks a year, devoting my time to The Nocturnists.

I think about doing a fellowship in palliative care, and I definitely love helping clinicians tell their stories. But I’ve lately been feeling an itch to develop my own creative voice. Whether that’s a book, a TV show, a film or a play by me or me and my team—I’m going to trust the process and see what pieces fall into place.

Phyllis Maguire is Executive Editor of Today’s Hospitalist.

Published in the March/April 2023 issue of Today’s Hospitalist

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