– Bethany Boulton and Charley McNabb
She’s the Texan research professor whose TED talk “The Power of Vulnerability” went unexpectedly viral nearly a decade ago. Her other special interest, shame, generally precipitates an uncomfortable rising heat when mentioned in conversation. Furthermore, throughout her research over the last 20 years, she has found – and proven – that one of the keys to successful leadership is courage.
So how do vulnerability, shame, courage and leadership come together? Walk with us a little….
Recently, we had the privilege of spending a little time with Brené Brown in Melbourne…. along with around 5000 other privileged folk. While her data has been collated from, and her theories have been applied to, all kinds of different industries, we were keen to apply her assertions to our own medical realm.
Daring to lead in medicine – The Challenge
Brené defines vulnerability as “uncertainty, risk and emotional exposure”. Sounds like everything we try to avoid, both personally and professionally! You might say that we cannot have vulnerability in health care – that we need to minimise uncertainty, risk and emotional exposure. However the philosophy reconciles itself when applied to relational vulnerability rather than systemic vulnerability. Of course she’s all for checklists and sponge counts!
In fact, Brené’s research has shown that without vulnerability, courage cannot exist.
Vulnerability is not weakness; it means having a go, risking failure and judgement, and experiencing that confronting feeling of shame. It takes some courage to make this leap. Vulnerability and courage, or strength if you will, are not opposites. They can coexist in the moment.
“If you are brave — and vulnerable — you will fail without doubt, but you will also rise again,” - Brené Brown
Lack of courage
When people are asked to define a concept, they tend to respond in a typically human fashion and define the opposite. For instance, Brené found that when she asked people to define courage, people told her what LACK of courage looked like.
Lack of courage looked like using ‘armour’ such as perfectionism, anger and control to self-protect or respond (to the threat of shame).
Lack of courage did NOT look like vulnerability.
In our context, this may be avoiding that difficult conversation with our colleague, to avoid fear of their response or discomfort.
It may be failing to listen to others or criticising their input.
It may be retreating into the ‘way we have always done things’ for a false sense of security.
What then does courage and vulnerability look like in medicine?
Take a moment to pause in reading this piece, and think back to a time when you have shown courage (and vulnerability) in your workplace? What did that look like? What was the response to your actions?
In Medicine, vulnerability might be asking for help when you don’t know the answer. It may be the junior doctor performing a procedure for the first time in front of a room full of people. It may be handing over the emergency department to the fresh (and potentially judgemental) faces after a tough night shift. Or when you throw your hat into the ring for a leadership position that you’re not sure you’re qualified to take.
In order to get better at what we do in medicine, we need to learn and grow in our skills and attributes as a doctor. To do this we need to be brave. We need to be prepared to make ourselves vulnerable to failure in order to grow into the best doctor that we can be.
Preventing Shame
Shame is rife in medicine. Some traditional teaching techniques in medicine – pimping, humiliation, public exposure of flawed thinking and decision making, can lead to clinical shaming, inducing us to feel unworthy. It also conditions us to avoid being courageous in the future.
Shame is the belief that we are not enough. It isolates and separates (disconnects) and is linked to poor self-esteem, addiction and mental health issues. Not surprisingly, these issues are all too common in medical professionals.
Shame is different from guilt. Shame is about identity. Guilt is about behaviour – and behaviour is separate to self. Guilt represents cognitive dissonance and can be protective and corrective.
Guilt says: I made a mistake. Shame says: I am a mistake. The distinction is subtle but clear.
In part 2, read about how we can apply these insights into our own context in medicine.
WRaP EM 
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