Latest / Flourishing in Medicine: From Surviving to Thriving / Flourishing in Medicine: From Surviving to Thriving Episode 24 Deep Connections: Dr. Will Bynum on The Heart of Medicine and Navigating Shame in Healthcare

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Flourishing in Medicine: From Surviving to Thriving Episode 24 Deep Connections: Dr. Will Bynum on The Heart of Medicine and Navigating Shame in Healthcare · Flourishing in Medicine: From Surviving to Thriving

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The practice of expressing humanity or humanities
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creatively in the work in healthcare or the work
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we do as physicians, I mean, I might actually
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say in a little bit of a provocative way that
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the fact that we even have to ask that question
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is telling, right? Because it should be, they
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should be so interwoven that we can't distinguish
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them. But the fact is that our biomedical models
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The ways that we're trained, our pedagogies,
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even our ontologies and epistemologies, the ways
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that we try to answer questions that are impossible,
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frankly, to answer, like, what does it mean to
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be? You know, what does it mean to be sick or
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well? That these have driven us to construct
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healthcare training programs and hospitals and
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deliver patient care in ways that detach us from
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the deeper human elements of that work. Welcome
0:55
to Flourishing in Medicine from Surviving to
0:58
Thriving. I'm your host, Dr. Mick Krasner, and
1:01
this podcast is produced by EmPRO, a medical professional
1:05
liability insurance carrier in New York State
1:08
who has a deep commitment for peer support offerings
1:12
to support the physicians they protect. In this
1:15
podcast, Flourishing in Medicine from Surviving
1:18
to Thriving is really focused on speaking with
1:20
thought leaders and other individuals about how
1:25
we as health professionals, physicians in particular,
1:27
and others could best thrive in this very complex
1:33
and fraught healthcare system within which we
1:36
work. The title of today's podcast is Deep Connections,
1:41
Dr. Will Bynum on the Heart of Medicine and Navigating
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Shame in Healthcare. I'm really excited to bring
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to you this conversation with Will Bynum. MD,
1:53
PhD, Associate Professor of Family Medicine at
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Duke University School of Medicine. Before joining
1:59
Duke, he served seven years on active duty in
2:03
the United States Air Force, including four years
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of faculty duties in the NCC Family Medicine
2:10
Residency Program, as well as deployments to
2:13
East Africa as Senior Medical Director of Special
2:16
Operations Command. Currently, he is the Duke
2:20
University School of Medicine Family Medicine
2:23
Residency Program Director and his primary scholarly
2:26
interests include the role of self -conscious
2:30
emotions such as shame, guilt, and pride in medical
2:34
learning. He completed his PhD studies with research
2:39
on this topic at the Maastricht University in
2:42
the Netherlands. Will shares in this conversation
2:46
his motivations for pursuing a medical career
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that was driven in part by his passion for science
2:51
and also his deep connections with people and
2:55
influenced by his service -oriented upbringing.
2:58
This conversation with Will explores teamwork
3:01
and selflessness and his journey into studying
3:05
shame. The discussion delves into efforts to
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advance shame awareness in healthcare through
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storytelling and research, drawing a paradoxical
3:15
contrast between the supportive military environment
3:19
he experienced and the judgment -laden healthcare
3:22
atmosphere that many of us find. The episode
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explores how fostering shame, resilience, and
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competence, especially through narratives, can
3:30
create a nurturing, more psychologically safe
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healthcare environment. Will is an enthusiastic,
3:37
optimistic, forward -thinking, and endlessly
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creative voice for flourishing in medicine. And
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now, our podcast. Welcome to Flourishing in Medicine
3:49
from Surviving to Thriving. Will, it's a pleasure
3:53
having you here. We know each other a little
3:55
bit, and this is another great opportunity for
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me and listeners to get to know you even more,
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so I'm really happy to have you. Thanks, Mick.
4:04
Thanks for the opportunity to be here, and it's
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always great spending time with you. I want to
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know a little bit about your why. medicine why
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medicine you know of all the things and all the
4:16
talents you have and all the things you could
4:18
have done you chose medicine people choose it
4:23
for a variety of reasons but when I talk with
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health professionals and especially physicians
4:27
there's often some common threads about their
4:31
origin story maybe something very early on something
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later in their work life or educational journey
4:37
before they started to train in medicine so whatever
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it is for you we'd love to hear about that that's
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a great question and it's interesting i would
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answer it about the same now as i think i would
4:50
have coming into medicine but i would probably
4:53
articulate the reasons for that answer a little
4:56
bit differently which has been you know kind
4:58
of a neat thing to to explore and discover over
5:01
my career Best way to maybe summarize it is just
5:03
to say that I've always just really loved connection
5:06
with people. I've just thrived on it. And while
5:11
I'm sort of a bit of an introverted soul in a
5:13
lot of ways, I've just always been drawn to really
5:17
deep, authentic connection with people. And medicine
5:20
is one of the places where that's most possible
5:23
and where I've had the chance to do that with
5:26
just such a diverse and amazing group of people.
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Coming into the profession, I loved being around
5:35
people. I certainly wanted to apply whatever
5:38
skills that I had to try to make life better
5:40
for other people and to serve. I definitely came
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from a service -oriented family. And then I also
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just love science, and I love the challenge of
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learning what was required to be in medicine
5:51
and be effective. Over time, as I've thought
5:53
more about why am I doing what I'm doing, professionally,
5:57
which is now a bit diverse. I mean, I do clinical
6:00
medicine, research, teaching. The service aspect
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and the connection with people aspect is 100
6:05
% still there. The reason now that I feel so
6:09
much satisfaction and joy doing it is it's something
6:14
more fundamental to what it means to be human.
6:17
And I'm still trying to work out how to really
6:19
articulate this, but it gives my life meaning
6:23
in ways that feel... authentic to sort of my
6:27
organism, if that makes sense. There's nothing
6:30
contrived about connection with other people.
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There's nothing constructed about it. It just
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feels natural. And so it's one of the ways that
6:39
in a world in which I think we have the chance
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to be dehumanized constantly or disconnected
6:44
from our core humanity, I find that my job and
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the people that I get to work with give me that
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chance every day. that's why i find so much meaning
6:54
in this work and why i love it so much it's the
6:57
same type of meaning i find in my relationships
6:59
outside of work too especially my family so yeah
7:02
i feel very fortunate you caught my attention
7:05
on something you said it was your service oriented
7:07
family because i was going to ask you to dig
7:10
a little deeper what about your upbringing what
7:13
about the environment your dna and the epigenetics
7:18
of that environment has made you feel service
7:22
-oriented and that's certainly a natural fit
7:24
with medicine. So could you say a little bit
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more about your service -oriented family and
7:29
milieu expectations or just sort of how it was
7:34
for you growing up in that environment? Yeah,
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my parents are just phenomenal people and I've
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had the privilege of getting to be mentored and
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sort of raised and cared for and loved by two
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people that exist for the benefit of others I
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mean they are truly selfless people and you know
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as a kid growing up maybe this is one of the
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first times I've ever even articulated or said
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it out loud but to be raised by selfless people
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is such a cool thing you know it's because they
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really just pour themselves into you and and
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then there's an unspoken expectation that you'll
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do that for other people and just because I think
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they see value in in that and there's a There's
8:19
some sort of a deeper sense of worthiness that
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comes from selflessly serving others. So just
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being, seeing them as role models and attached
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closely to that is humility. You have a very,
8:30
very successful father who's always been good
8:33
at everything he's done. And the only reason
8:36
I know is that other people have told me, you
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know, or I've seen some sort of other evidence
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of it. And I just have so greatly valued watching
8:46
him succeed. these really selfless and humble
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ways. I also just was, you know, I grew up in
8:53
school and in a church life that, you know, my
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parents sort of engaged us in, in which service
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was just a normal part of what we did. I mean,
9:02
service projects, helping people build homes,
9:05
addressing homelessness or poverty, some global
9:09
work. And those were really not only eye -opening
9:12
for me, but also I found this. consistent, authentic,
9:17
powerful connection with people no matter where
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I was and with whom I was working, whether we
9:23
were serving them, I was feeling served by them,
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or we were just working kind of side by side.
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So I've just found so much positive energy, I
9:31
guess, and just satisfaction and probably ultimately
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self -worth through being in connection with
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others. And as I've gotten to be an adult, I've
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needed to curate a lot of those things for myself.
9:43
You know, I don't have a family sort of driving
9:45
me into those things anymore. And this profession
9:48
just offers abundant, endless opportunities to
9:51
do that. Something you and I share in common.
9:54
I also feel like I was raised by amazing parents.
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I was number five of six children. And also when
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you said selfless, you know, I thought to myself,
10:03
I've never really thought of my parents like
10:06
that, but they actually were in what they did
10:09
in actually putting all that focus. on the six
10:13
of us and everything they did had us in mind.
10:17
And I think that gave me a sense also of being
10:19
wanting to do something that was an expression
10:23
of that that I benefited from. So that's really
10:26
lovely to hear. I'm also interested in the service,
10:30
knowing that you had a military service. Can
10:35
you connect us with your military service? and
10:38
not only how it came out of perhaps if it did
10:41
come out of that why that you described just
10:45
a moment ago but also what is it about that military
10:48
service maybe that has contributed to your sense
10:51
of your own personal flourishing yeah i had a
10:55
really interesting to me at least um sort of
10:59
journey into the military it was not one of those
11:02
preordained things nor was it something that
11:04
i had always wanted to do i do not want to paint
11:07
myself as someone that was just really anxious
11:10
and and desperate to serve my country in this
11:13
way frankly i my father was in the military in
11:17
the reserves for a career my grandfather and
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uncle were career military officers and so i
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was certainly aware of it and highly respectful
11:26
of the institution but it became sort of a an
11:30
option for me when i got into medical school
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and had to think about how to pay for it and
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then it was like a no -brainer really i mean
11:36
at least that's how the um the recruiter made
11:39
it seem as he backed me into a corner and and
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before i knew it i was sort of signing at least
11:43
the next seven years of my life or more 11 years
11:46
at the time to the military but it makes a ton
11:49
of sense that it's where i ended up for a big
11:52
portion of my career so far i mean in some ways
11:54
it felt serendipitous in other ways it felt a
11:56
little inevitable coming from the back the family
11:59
background i came from and the desire to be a
12:02
part of something bigger than me And, you know,
12:04
the irony of that is that when you're in medical
12:06
training and medical learning, it's all about
12:08
you. You know, medical training and even the
12:12
career in many ways is inherently a bit self
12:14
-centering because of just what it demands of
12:16
you. And so while I was going through some of
12:20
the experience of that, of having to center my
12:22
world around my learning and education and skill
12:25
acquisition and all that, at the same time, I
12:28
was also having to conceptualize myself as just
12:31
a an important part, but by no means the most
12:36
important part of a much bigger system of the
12:38
military. And that's one of the ways the military
12:40
really functions so effectively is that nobody
12:43
is more important than anybody else. And that
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is not always a mentality that we carry in healthcare.
12:51
So from an early stage, it gave me some sort
12:55
of a kind of contextual balance to the demands
12:58
of my training. And then when I got into the
13:00
military, I needed some assimilation. I remember
13:04
going to my officer training after I graduated
13:07
med school and I walked onto campus down in Alabama
13:10
of the military base and I mean literally walking
13:13
from my car to the building I was you know in
13:16
a line up against the wall essentially getting
13:18
kind of dressed down by one of the trainers and
13:21
it was like you're in the military now and I
13:23
was a little shell -shocked. by that you know
13:27
later that day we were marching in a formation
13:30
and we didn't even have uniforms yet and i remember
13:32
feeling so awkward and almost out of my body
13:34
and then days to weeks later you know this is
13:37
a month a month on training i couldn't get enough
13:39
of it there's a sense of sort of comfort in the
13:42
relative anonymity of being in the military where
13:46
it's like you're you have to create ways of knowing
13:50
and expressing yourself as an authentic person
13:52
but you're doing it within this sort of cocoon
13:54
of we're all the same in a lot of ways here and
13:57
i really loved that i did for me that was a bit
14:01
of a securities blanket and then over time maybe
14:05
where i most understood and was affected by what
14:09
it means to be in the military at least for me
14:11
was when i was deployed in east africa and i
14:13
went with special operations and i was a senior
14:15
medical director in the area and my job was really
14:19
important but again in a different stratosphere
14:22
of importance than than the operators that were
14:25
out doing the missions. And there was a term
14:28
that was used for people like me, me, the logistics
14:30
people, the food people, called enablers. And
14:34
I just loved that term. I was so struck by it.
14:39
And I just leaned into it so hard of being the
14:42
enabler of the mission. It was like, you're important,
14:46
you're critical, but everything you're doing
14:48
is for somebody else to be able to do their job.
14:50
And that's how I actually see myself in medicine.
14:53
It's how I see myself as a teacher. as a clinician,
14:55
that really my job is just there to enable and
14:58
to try to facilitate. And what's refreshing about
15:01
that is that I'm never more important than anybody
15:03
else that I'm working with or serving. And that
15:06
just feels, actually, it takes a lot of the pressure
15:09
off of having to be a certain way as a physician.
15:13
That's really interesting how you started out
15:15
by talking about or making the statement that
15:18
a medical career by its nature at least training
15:21
and all that is in some ways self -centering
15:23
because of what it demands of you and then becoming
15:26
part of a different kind of system of organization
15:29
in which there was a shift in your sense of self
15:32
that it was really a shift in team and now we
15:34
know so much more about collaborative models
15:37
of medical care being really the way that we
15:39
actually get things done and do the work so i
15:43
can see all of that With that in mind, can you
15:46
just talk to us a little bit about then how you
15:50
decided to serve as a medical educator? What
15:54
led you to medical education as among so many
15:58
career choices coming out of the military, coming
16:01
out of medical training that you had? That was
16:05
another unfolding, if you will, in my career
16:10
that kind of surprised me and just happened.
16:13
it didn't just happen but it was not something
16:15
that i set out to do you know knowingly really
16:18
early on if i really zero in on this kind of
16:23
the initial spark it was just some mentors i
16:25
mean i got a an opportunity to to serve in a
16:28
national medical education organization as a
16:31
fourth year med student on a board of directors
16:33
and just found myself all of a sudden sitting
16:36
in a room of like these amazing people having
16:38
amazing conversations and talking about things
16:41
that were really interesting and stimulating
16:42
to me and i i just thought right away like wow
16:45
this feels like the type of place i want to be
16:47
in you know and the people i want to be around
16:49
and then i also found in med school and med school
16:53
was so so formative for me because it was it
16:55
was like the first time i really applied myself
16:57
you know to one thing i just pretty well rounded
17:00
before and maybe just also not super as driven
17:03
as i had the potential to be towards any one
17:06
thing and then i got to med school and it was
17:07
like oh wow you know i'm super passionate about
17:10
this and you know i have some aptitude for it
17:13
and then it was a matter of just finding myself
17:16
wanting to like share some of the ways that i
17:19
maybe understood things with people around me
17:21
and then receive that understanding back from
17:23
them so i was a real collaborative learner in
17:25
med school and it really um that love of interaction
17:31
and of trying to come up with new and more meaningful
17:36
or impactful ways of absorbing the just the massive
17:40
information that was thrown at us all the time
17:43
it was really stimulating for me and so i just
17:47
came to find myself with someone that liked to
17:49
teach and at the same time was finding this community
17:53
in medical education that just felt like you
17:55
know the people i wanted to be around the problems
17:57
i wanted to try to solve and then that's carried
17:59
me through i mean i teaching is so rewarding
18:02
i mean it's so so rewarding It's really hard,
18:06
and I would say it can be really hard in medical
18:08
education in particular because of all the challenges
18:11
of this learning and the learning environments
18:13
we encounter. But it was just back to that human
18:16
connection. I mean, teaching is just another
18:18
way of serving, especially if you're willing
18:20
to teach as selflessly as you possibly can, which
18:23
is also hard. Okay, so I'm going to have us kind
18:27
of hone in on a big part of your current mission
18:32
in teaching, we could say. You know, as an educator,
18:35
as a now a social scientist, as a clinician,
18:39
you've made a name for yourself and your and
18:42
your colleagues with your colleagues in this
18:45
domain of shame. And could you just like you
18:48
did in the origin story of your medical decision
18:52
to be in medicine, that is, can you tell us a
18:55
little bit about the origin story of. shame,
18:57
why that is a subject of investigation, exploration,
19:02
and also teaching, and if you could say treatment,
19:06
how these experiences live in us, inform our
19:09
actions, behaviors, etc., and contribute to the
19:12
culture of medicine. We'd really love to hear,
19:15
our listeners would love to hear about this story,
19:17
which I know you've told in many places, but
19:19
please share it with us. I tell people anytime
19:22
I get asked this question that I never, I get
19:24
sometimes called the shame guy. somebody will
19:27
see me and they'll be like wait a minute oh you're
19:29
that shame guy in medicine i'm like i've had
19:32
to just sort of lovingly adopt that term i certainly
19:35
didn't ever set out to be a shame guy and don't
19:38
even know what that would have meant um the time
19:41
but it's something that that i truly stumbled
19:45
or just kind of fell flat into in residency and
19:49
it happened when there were some intersecting
19:53
experiences and forces going on for me in a way
19:55
that really catalyzed kind of this huge period
19:58
of growth for me that was very painful at times.
20:02
Briefly, those intersections were, well, for
20:05
one, I was just developing a real interest in
20:07
academics. And so it was natural for me to be
20:10
looking around at the world around me, trying
20:12
to find problems to solve. But I was looking
20:14
for some pretty mundane ones at the time that
20:16
didn't seem to matter that much. So I was really
20:18
looking. I was not looking for shame by any means.
20:22
the second was a i was in the tail end of kind
20:26
of a bad relationship that it wasn't like overtly
20:29
bad it was sort of insidiously bad where this
20:33
was a someone that i dated for a while who was
20:37
ended up leaving to move to new york and i just
20:40
was probably a little bit chronically maltreated
20:43
a little bit i don't even know if the treatment
20:45
was a problem but i irrespective of what was
20:49
happening from her I developed a low grade, but
20:54
really potent degree of self -doubt and eventually
20:58
like, what's wrong with me? You know, why am
21:01
I not worth sticking around for? Why am I not
21:03
worth, you know, whatever it is that I didn't
21:05
think she was doing. That was really sort of
21:08
unsettling for me at the time because I had always
21:10
had a relatively strong sense of self and it
21:13
was really rocky. At the same time, I was in
21:16
residency and all the ups and downs that come
21:18
with that and all the vulnerabilities. And in
21:21
the same sort of period of time, I've told this,
21:24
this is a story I've told a lot, but I was just
21:26
in a labor and delivery shift. And the long and
21:28
short of it is that I made a medical error that
21:30
really hurt the mother during a childbirth. It
21:34
was a really like true and true type of public
21:39
bad outcome that you're just always fearing as
21:44
a physician or as a medical learner or any health
21:46
care professional. i can't even remember which
21:49
one came first that or the breakup but both of
21:52
them led to this in their own way and maybe additively
21:57
this just huge massive emotional avalanche frankly
22:02
that that culminated in me just feeling you know
22:05
worthless as a physician like someone that hurts
22:07
people like someone who doesn't you know isn't
22:10
good enough to be in medicine isn't worthy of
22:13
being trusted was a very strong performer up
22:16
to that point and thought all that was a fake
22:18
and a fraud, you know, and this was real me.
22:20
And at the same time, also just not really knowing
22:23
who I was outside of medicine and feeling kind
22:25
of adrift there and sort of some deep -seated
22:28
self -doubt about me, the person. And the culmination
22:31
of those two at the same time was very jarring.
22:33
I mean, and I was also having to continue with
22:35
my residency training and just trying to live
22:37
a normal life and all that. As I recovered from
22:40
both of those, I did a few things, but one of
22:43
the key things I did was just to start reading
22:44
about, I mean, I went to the, I went to the Barnes
22:48
and Noble self -help section, like three different
22:50
times. There's a section on self -help and I
22:52
was like, put a, I like put a hat on and, you
22:54
know, like kind of pulled my jacket up around
22:57
my face. And when we just see me like perusing
22:59
the self -help section too much, that's talk
23:01
about the stigma of, of these things. Right.
23:03
I was almost ashamed to just be needing. some
23:07
self -exploration. And I read some books and
23:09
eventually I came across Brene Brown's TED Talk
23:11
about shame and vulnerability. And it was like
23:14
the curtain lifted and the fog lifted. And it
23:17
explained everything that I was feeling, that
23:19
emotion. And frankly, the rest is history. I
23:21
mean, once I kind of figured out what I was going
23:23
through, I started looking around me with that
23:25
lens and seeing shame all around me in healthcare
23:29
and in medical education. And yet nobody was
23:32
talking about it. Nobody was researching it.
23:35
I was shocked that the literature was almost
23:38
absent about sort of explicit attention to shame,
23:40
despite lots of signal for it. And so, you know,
23:44
I just kind of dove in headfirst and some mentors
23:47
eventually pushed me into research. And, you
23:49
know, here we are. So I'd like to unpack a little
23:54
bit of that by. Just sharing something I read
23:58
about the Shame Space Consortium and then ask
24:01
you some questions there because I think that'll
24:02
help our listeners kind of understand the approaches
24:06
and a little bit more about shame. So you described
24:09
it or the consortium describes themselves as
24:13
a network of professionals who use creative storytelling
24:16
and research to advance shame awareness, shame
24:20
resilience, and shame sensitivity practice in
24:23
healthcare. And the goal is their to create a
24:26
more connected, authentic, and safe healthcare
24:28
system for everyone. So I wanted to start with
24:31
the storytelling. I want to ask questions about
24:34
the storytelling. What is shame resilience and
24:37
shame sensitivity practices? So maybe we can
24:39
start with storytelling. Why storytelling? And
24:42
why have you found that to be something that
24:45
will help our colleagues and other health professionals
24:48
and learners work with this dynamic of shame?
24:52
Well, I'll just say first from sort of a humanistic
24:54
perspective that, you know, shame is a really
24:57
fundamentally personal and often very challenging
25:02
emotion. It comes from a self -evaluation. So
25:05
we engage in some form of assessing ourselves
25:08
or feeling like others are assessing us and that
25:11
we are deeming ourselves to be or others are
25:14
deeming us to be unworthy or flawed or deficient
25:17
in some way. So it's sort of a global negative
25:20
feeling of. of judgment either from ourselves
25:23
or from others that are often projections of
25:26
our own self -evaluation so you know because
25:30
shame is so personal it's also it's also very
25:32
stigmatized and we often feel shame for feeling
25:35
shame it can really be a hard emotion to grapple
25:38
with to connect with we often take efforts to
25:41
repress it or to avoid it displace it that we
25:45
need sort of emotionally accessible access points
25:50
for this emotion right to engage with it think
25:53
about it and talk about it and narrative is one
25:55
of the most effective ways we found to do that
25:57
and it's because our stories are who we are and
26:01
we are our stories and so there's something very
26:04
humanizing about talking about shame through
26:07
narrative and through story because we don't
26:09
abstract it too much we don't talk around it
26:12
i mean when we talk about our shame experiences
26:14
as stories we are narrating what it means to
26:18
be us. And to have someone else be willing to
26:20
listen to that story, receive it, and maybe not
26:23
even respond, but just receive it, validate it,
26:25
can be incredibly humanizing in the midst of
26:28
the more sort of disconnecting nature of shame.
26:32
So there's real practical significance that stories
26:35
bring with it. From the research perspective,
26:38
I can sit here all day and tell you what our
26:40
data say. Ours is qualitative, coming from a
26:43
lot of stories. So it's still hard, though. to
26:46
sit and tell you too much about the nuts and
26:48
the bolts of shame, certainly if there's any
26:50
quantitative data to tell you about shame, without
26:54
connecting it back to its fundamental nature
26:56
as a human experience. In other words, if we
26:59
overly analyze and detach this experience as
27:05
something that can be analyzed and researched
27:07
from its nature as a human experience, we're
27:10
actually going to, I think, do the topic disservice.
27:12
So what narrative does is it allows us to bring
27:16
research findings into the lived experiences
27:20
that we all have day to day as people, as opposed
27:23
to just some abstract sort of body of data that
27:26
tells us about phenomena for which we're disconnected.
27:31
Yes. And I appreciate it in the shame conversation
27:34
film, you know, even the little bits of those
27:37
narratives that showed up there really was made
27:39
it much more human. We will definitely include
27:42
that in the show notes for this. podcast conversation.
27:45
It's really interesting. I'm thinking back to
27:47
what you said earlier, the example of showing
27:50
up in the military and being dressed down and
27:53
then, you know, having to march and being very
27:55
self -conscious about marching without your uniform.
27:58
And then later feeling like you need more of
28:01
that. I think that self -conscious part of that
28:05
experience, perhaps you can tell me my analysis
28:08
is that it became a little less because of there
28:11
was a whole group of people you could identify
28:14
all going through the same thing versus the self
28:17
-centeredness of the medical career and you mentioned
28:19
the emotion and stigma and shame itself and how
28:24
self -conscious it is so i just would like you
28:28
to reflect on that maybe the difference from
28:30
how you frame that experience in the military
28:32
that you shared with us that little story and
28:35
then how the experience of the medical error
28:39
was so different than you know being dressed
28:43
down by a military officer or something yeah
28:48
it's a great question and it's it's an interesting
28:51
thing to try and analyze but there's something
28:54
about all wearing the same uniform all adhering
28:59
to the same code all wearing ranks that are way
29:03
bigger than us I always tell people when people
29:07
walk by a military person and salute, they're
29:10
not saluting the person, they're saluting the
29:12
rank. Like it's not, this is not about you, right?
29:14
This is about the system and the structure and
29:16
the organization and all that it needs to function.
29:19
That there's something safe about being on a
29:24
level playing field with people where it's like,
29:26
you know, what it really, what it really is,
29:28
is a shared experience. I mean, we're all having
29:30
this shared experience here together. We're all
29:32
pretty awkward in doing this. Even though we're
29:35
all trying to act like we have it together, and
29:38
I've actually found in the military that there's
29:40
much more comfort with not knowing what you're
29:45
doing. There's a lot less drive for impression
29:48
management, in my experience in the military,
29:50
than in healthcare. You know, if I screwed something
29:52
up in the military, the explicit expectation
29:54
was always, you just got to fix it for next time.
29:57
And when I screwed something up in healthcare,
30:00
there was rarely, often there wasn't any sort
30:03
of... follow on from that. I just had to recover
30:05
from it on my own. But I was always so much more
30:09
aware of how people might be judging me. I perceived
30:12
a lot more judgment in healthcare or the risk
30:15
of judgment than ever I ever did in the military.
30:17
And another way of saying that is that I wrote
30:19
a paper about this, actually. When I was preparing
30:22
for my deployment, I did some training in combat
30:25
skills. So I'm a guy that just, you know, I shot
30:28
a squirrel when I was a kid and I like bawled
30:31
my eyes out. I'm not a killer. I'm not a shooter.
30:34
i'm in decent shape but i'm not i'm insecure
30:37
about my ability to go out in a combat unit right
30:39
and manage appropriately so i went into this
30:42
training like just sort of a bit of a nervous
30:44
wreck and then at the same time i did a few weeks
30:47
later i did a trauma refresher course in a big
30:50
teaching hospital right so very similar high
30:52
stakes high intensity high fidelity work being
30:55
done And I found the military combat skills environment
30:59
to be far safer psychologically than the health
31:02
care training environment. And that's an interesting
31:04
paradox, right, that you would think that it's
31:07
health care, right? I mean, we take care of sick
31:09
people. We help them. We're a place that people
31:12
come for comfort and healing. And yet it feels
31:15
less safe than the combat skills environment.
31:19
And so I really thought I reflected a lot on
31:21
that paradox. And there's actually a lot that
31:24
health care and military have in common. We all
31:26
do have a mission that's bigger than ourselves.
31:29
We all are here to serve others. We all work
31:32
in teams on which no one is more important than
31:34
the other, even if roles are different. So why
31:37
is it that we function so differently? And I
31:39
think in the military, the mission and the importance
31:45
of team was so foregrounded that nothing you
31:49
ever did individually could supersede that. meaning
31:52
your successes and your failures and so if you
31:55
failed it was really looking at how can you improve
31:57
this failure for next time to help your team
32:00
whereas in healthcare so often failure feels
32:03
like this like personal transgression and i do
32:07
think we judge more and i think we compare a
32:09
lot more and i think that being able to sort
32:12
of express ourselves authentically is is constrained
32:16
more in healthcare we're very achievement oriented
32:19
we've all been kind of brought up in these pathways
32:22
of trying to be the best at something and and
32:25
it's a laudable it's a laudable goal because
32:27
being the best at something means you take care
32:29
of good care of people but so much of our self
32:31
-worth becomes dependent on being the best and
32:34
failures to do so become threats to that self
32:37
-worth i never experienced that in the military
32:39
i mean it was like we were all just everybody
32:41
wanted to work hard to be better you know and
32:44
but it was better for something that was outside
32:46
of you when i think back about my military experience
32:50
that's somewhat ironic is that I always felt
32:53
really cared for in those environments. So almost
32:56
like almost nurtured. And I know that's not the
32:59
case for everyone in the military. So I don't
33:00
want to say the military is uniformly a nurturing
33:02
organization, but I always experienced that.
33:04
And in some ways it's because there was always
33:07
a structure around me that was there for me.
33:09
And there was a sense of just mutual ownership
33:14
of each other's wellbeing that felt, made you
33:19
feel safe. And I do think that exists in healthcare
33:22
at times. I think we grossly underutilize our
33:25
capacity for that, though. We take such amazing
33:27
care of our patients so often, but we really
33:30
have a chance to nurture one another more so
33:33
that anyone walking into a healthcare facility
33:36
to work on any given day should feel like they're
33:39
a part of an organization that truly cares about
33:41
them. Not just the organization, but the people
33:43
around them care about them. And feeling cared
33:47
for is one of the probably the strongest sort
33:50
of antidotes to feeling shame. Because it's not
33:53
even just that you feel cared for, you feel worthy
33:56
of being cared for. And that's a really warm
34:02
and helpful and growth -orienting feeling, especially
34:04
when you're struggling. You know, this makes
34:08
a lot of sense. you know we're all sharing this
34:10
experience it's kind of how you opened in the
34:13
military model and also true in the health care
34:16
model but something happened so normalizing that
34:19
being part of a common humanity that also feels
34:24
emotions like shame and guilt and those sorts
34:26
of things is one way that i think your program
34:29
is finding the kind of doorway into making this
34:33
a useful place of change in our healthcare ecosystem,
34:39
in our environments. Can you just define for
34:42
us a little bit about shame resilience and shame,
34:45
what you mean by shame -sensitive practices?
34:49
Luna Dolezal, my colleague in the UK, and Luna
34:53
and I co -founded the Shame Space and the Shame
34:55
Lab, have had a lot of great discussions recently
34:58
about shame resilience. And we've really come
35:02
to a term that we find to be a little more practical
35:04
and useful and even a little bit less polarizing
35:07
which is shame competence i'll tell you what
35:09
shame competence means in a minute i do think
35:11
shame resilience is a thing and i think it's
35:13
it's being either in a state of sort of self
35:17
-regulatory ability emotional regulation ability
35:21
of self -awareness of connection with others
35:24
in which you can experience shame and move through
35:27
it in a way that is growth -orienting, self -concept
35:30
enhancing, and yields and aids active recovery.
35:36
The reason we talk a lot about shame competence
35:38
is that we don't think that we or anyone's really
35:40
equipped to go out and teach people how to be
35:42
shame resilient. I think that's something that
35:44
is a journey that you go on in and of yourself.
35:47
And if you're not shame resilient, it doesn't
35:49
mean something's wrong with you. It just means
35:51
maybe there's opportunity to find new ways of
35:53
being resilient. Shame competence, on the other
35:55
hand, is a set of skills and abilities and practices
35:59
that can be learned and they can be taught. And
36:02
then they can be implemented in ways that help
36:05
people engage with shame in more constructive
36:08
ways, right, that leverage its pro -social potential,
36:11
because it is an important emotion that we can
36:13
feel, and then mitigate its more destructive
36:17
potential. And so when we, as we've kind of come
36:20
to conceptualize shame competence, it is comprised
36:23
of five pillars so the willingness and ability
36:27
to maintain awareness of the possibility of shame
36:29
within any interaction within yourself within
36:32
a team at any given time the ability to recognize
36:35
it the ability to avoid inducing shame accidentally
36:40
or intentionally the willingness and ability
36:42
to support another person who's experiencing
36:45
shame or to seek your own proactive support for
36:48
yourself and then the fifth pillar is the ability
36:51
to transform So transform an organization, a
36:53
team, through the application of shame confidence,
36:57
ultimately in the spirit of shame -sensitive
36:59
practice. So shame -sensitive practice is when
37:01
we do the work that we do professionally in a
37:04
way that is attentive to the possible existence
37:07
of shame, that proactively engages with it, that
37:10
avoids its intentional induction, and that ultimately
37:14
creates the conditions through which all that
37:15
can occur. Very, very helpful. And I could see
37:21
how shame competence and the practices, the shame
37:24
-sensitive practice, leverage that pro -social
37:27
potential and mitigate that destructive potential
37:31
in a way that you were talking about nurturing,
37:34
about being nurtured. And I can't help but mention
37:37
Vivek Murthy, our Surgeon General, who wears
37:41
a military -type uniform, who is the figurehead
37:44
of our healthcare system, one could say. who
37:47
is speaking this language. He's talking about
37:50
nurturing and having our backs and really helping
37:54
medical community. So I think it's really interesting
37:57
how that becomes a national presence for all
38:01
of us in health care. I want to just shift now,
38:04
Will, to something that I've had the pleasure
38:07
of seeing you present and your materials and
38:10
your ideas in such a beautiful way using media
38:13
and creativity. And there's something about creativity
38:17
for me i love kind of engaging in that and i
38:20
feel like it's really important for me to nourish
38:24
myself so it may seem an odd question or an odd
38:27
segue but have you thought about physician and
38:30
health professional wellness and the creative
38:33
media the arts humanities being connected in
38:36
some way in the way that you have connected your
38:40
own presentation and expression of your work
38:43
in shame maybe you can unpack that a little bit
38:46
yeah that's an easy question because they're
38:51
deeply inherently interwoven the practice of
38:55
expressing humanity or humanities creatively
39:00
in the work in health care or the work we do
39:02
as physicians i mean i might actually say in
39:06
a little bit of a provocative way that the fact
39:09
that we even have to ask that question isn't
39:11
is telling right because it should be they should
39:14
be so interwoven that we can't distinguish them
39:16
but the fact is that our biomedical models the
39:20
ways that we're trained our pedagogies even our
39:24
ontologies and epistemologies the ways that we
39:26
try to answer questions that are impossible frankly
39:30
to answer like what does it mean to be you know
39:32
what does it mean to be sick or well that these
39:36
have driven us to construct healthcare training
39:39
programs and hospitals and deliver patient care
39:41
in ways that detach us from the deeper human
39:45
elements of that work and whether that's our
39:49
you know sort of the objectivist focus that we
39:52
take, whether it's our need to create emotional
39:54
distance from our patients so that we don't have
39:57
our quote unquote thinking or judgment clouded
40:01
by emotion and by subjectivity, whether it's
40:04
the rigid hierarchies through which we deliver
40:07
high intensity patient care, but also reassert
40:11
power. I mean, all of these things are baked
40:14
into the ways in which we practice, teach. receive
40:18
healthcare that detach us from the more just
40:22
deep, fundamental human aspects of that experience.
40:26
So we do need to be asking why, if they're connected,
40:31
we need to be thinking about ways to drive humanities
40:35
much more deeply into the integration of patient
40:39
care and caregiving and healing. But we also
40:43
need to kind of critically reflect on why it
40:45
is that that's not happening naturally and maybe
40:48
trace back to where it is that we began to sort
40:51
of diverge either the you know science from from
40:55
humanity i think that that would take us to some
40:58
interesting places and i really do believe that
41:01
health care for all of its human dimensions across
41:06
which it's practiced can be fundamentally dehumanizing
41:10
and existing in that paradoxical space can be
41:14
very disorienting you know especially for folks
41:17
who come into the profession wanting that human
41:18
connection to find that it often can be hard
41:22
to find or has to be worked for or is just not
41:25
possible is can be a bit jarring i really love
41:29
the way you frame that as like why isn't it there
41:32
rather than what's the connection because obviously
41:35
and it is obvious to me and to you that there
41:38
is a connection um one way of investigating this
41:41
if you would is to do a little thought experiment
41:45
with me. And so let me outline the experiment.
41:48
And then I'm going to give you a series of possible
41:50
questions and you can address any or all of them.
41:53
So imagine you're in a world three to five, 10
41:57
years from now, even in which our colleagues
42:00
have come out of the current crisis, whatever
42:02
we want to, however we want to describe it in
42:05
healthcare with the following, with robustness,
42:08
with energy, creativity, with commitment. In
42:13
fact, they've developed shame competence, let's
42:16
say, and shame awareness, and they're actually
42:19
engaged in shame sensitivity practices regularly.
42:22
So these are the kind of questions I want you
42:25
to reflect on, like I say, any or all of them.
42:29
What would your experience of practicing medicine,
42:32
being one of these colleagues in this imaginary
42:34
world, be like for you? What would it be like
42:37
for you to be part of a team of colleagues in
42:39
this imaginary world? what would others notice
42:43
about you and your colleagues and what qualities
42:46
and virtues would be part of your and these other
42:50
individuals professional experience and then
42:53
finally i know there's a lot here but i want
42:57
to give you a lot to work with what would they
42:59
have had to learn in that three to five to ten
43:03
year interval between now and this imaginary
43:05
world in order to get there The question of what
43:10
would people see in me, I have to say, I mean,
43:12
in many ways, and I think I'm very lucky. A lot
43:16
of what you just described, how you'll be coming
43:18
out, you know, is invigorated and connected and
43:22
all those things. You know, I feel that way now.
43:25
I mean, I have my days, definitely. And I have
43:29
my weeks. And there are times when the system
43:32
and the challenge of meeting providing the type
43:37
of care you want to provide and that people need
43:40
to receive can be so incredibly demanding and
43:43
taxing and on those days yeah i i feel like the
43:48
five to seven ten year transformation you talked
43:51
about is really apt then there are other days
43:53
where i feel that vigor and that energy and i
43:56
think what you what you see on those days and
43:58
you would see if i could have that every day
44:00
is just someone that just loves is just happy
44:02
just like energized you know, lighthearted, connected,
44:09
misty -eyed even. I mean, just kind of like,
44:12
you know, it's just that feeling of awe that
44:15
you get to have in the work that you do. I think
44:19
that you would see interactions among people
44:23
working together in healthcare that are just
44:25
fundamentally and consistently respectful. That
44:28
would be person validating. That would be benefit
44:33
of the doubt giving. That would be judgment diminishing
44:37
I mean it we would be interacting with each other
44:39
in ways that just are the ways you want to be
44:42
treated by a friend or by someone that you love
44:45
and that you hope loves you back I think we would
44:48
you would hear more open conversations about
44:50
emotions you would hear open conversations not
44:53
only about the challenging emotions we feel but
44:55
also the really uplifting ones you would hear
44:58
people talking more about the actual real life
45:01
on the ground experience of going through going
45:05
through this and not some whitewashed version
45:07
of it or some just frustration fueled event session
45:12
about it you would just hear more authenticity
45:14
and naming those experiences and then you would
45:18
find a lot more acceptance of them you would
45:21
find forums created through which they could
45:23
occur you would also find them happening spontaneously
45:27
you would find much more unrestrained self -expression
45:32
from healthcare professionals You would find
45:35
less assimilation pressures. You would find less
45:37
influence of deeply steeped tenets of professionalism
45:41
that work for people like me and you, Mick, but
45:44
not for people who are outside of this dominant
45:47
norm that we get to inhabit. I think you would
45:50
find patients that feel more connected to their
45:52
doctors. I don't know that. I think the care
45:54
would be better, frankly. I mean, I think the
45:57
care would be better. I think they would feel
45:59
like their doctor has more. and that they're
46:04
not always operating at the end of their bucket.
46:07
But I actually think patients more so would feel
46:09
like they get to know us more, that they get
46:11
to be more of a part of our lives, that they
46:13
get to feel more a part of our emotional journeys
46:17
as we work with them. I think that's something
46:19
that patients crave a lot of the time, especially
46:21
as they come in with so much vulnerability. To
46:23
get to sense a little bit of ours back, I think,
46:25
would be something you'd notice. Maybe the root
46:29
of all of this is we would just be a more connected
46:30
system. of people, not of work and not of data
46:35
and not of diagnostics, but people. And the reason
46:40
I think that is seeming increasingly revolutionary
46:43
is that the more and more tools that we generate
46:46
to make healthcare more efficient and diagnoses
46:48
more accurate, treatments more successful are
46:52
moving us farther away from that fundamental
46:55
connection. I think that we all really are craving
46:57
right now. Wonderful. A subject for another interview
47:03
and conversation with you, perhaps. So we're
47:06
kind of coming to the close here. And I learned
47:10
about you that you love coffee. You like cookie.
47:15
You said a daily cookie. It's beyond me how you
47:18
didn't put plural cookies, writing music and
47:22
not sleeping much. You have got a family, you
47:25
and your partner there. So can you tell us about
47:29
fun in your life, enjoyment. One, why you feel
47:32
that is so connected to you being human and also
47:35
your professionalism. But what other things do
47:38
you like to do that kind of rounds out our sense
47:41
of who Will Bynum is? Yeah, thanks for that question.
47:46
I have a four and a five -year -old and my partner
47:49
and wife, Carson, I just adore any time spent
47:53
with them. It feels like a hobby. At times, it's
47:56
a huge chore with my kids. But it's even a chore
47:59
that I just embrace and love. I mean, so lately
48:01
the things that I truly most enjoy doing are
48:04
things that I find enjoyment in and that my kids
48:06
find enjoyment in. And then getting to do it
48:09
all together is like a different level. It's
48:11
like a cloud nine. So I've been taking a fishing.
48:15
We're moving into a new house that has a big
48:17
yard and has a garden. And I'm like, we're growing
48:21
vegetables. We're like making compost. All this
48:24
stuff is, you know. meaningful to me, but to
48:26
do it with my kids is like the coolest thing
48:29
ever. I mean, it's just, it's the most fun I've
48:31
really ever had. It's sad to say, but I'd almost
48:33
rather hang out with them doing these things
48:35
than like my actual friends. No offense, but,
48:38
you know, so I've also, I always, I love building
48:41
things, you know, and the work that we're doing
48:44
with Shame, you know, some of which we're doing
48:46
with some of your colleagues with Impro. We're
48:49
getting to build some really neat things with
48:51
very talented people to try and bring this topic
48:54
to, bigger audiences and make a difference that
48:57
one of the coolest things about my career is
48:59
that I get to do my hobby is my work and my work
49:03
is my hobby. So that's something I actually really
49:06
enjoy doing. I do for fun. And then, you know,
49:08
I love sports, but the things that really get
49:10
me going right now are like new experiences with
49:13
my kids where we're all just learning something
49:15
new together or experiencing the world in some
49:17
new way. It's really interesting how these are
49:21
all connected to the professional and the personal
49:23
and all connected by, Human, humanist, being
49:26
human, humanity. You know, when you were describing
49:29
building this garden, being out there in this
49:31
new home of yours, and I'm thinking about the
49:34
earth and humus, humus, humility, humanity, they
49:39
all have the same roots, right? So it's really,
49:41
it makes total sense. Well, this has been a wonderful
49:45
time spent with you, Will, and I hope to have
49:48
you back sometime. Thank you so much. Yeah, great
49:52
conversation. And I love the work you're doing.
49:55
There's been some other great interviews. I can't
49:57
wait to hear them. And I'm excited to keep working
50:00
together moving forward. Thanks very much for
50:03
listening. We will, of course, include a summary
50:06
of today's podcast and links about Dr. Bynum
50:10
and other references that were discussed in the
50:12
show notes. I'd like to conclude by sharing another.
50:16
exercise, practical exercise, that I think could
50:19
help you flourish. During the conversation with
50:23
Dr. Bynum, he spoke of what the experience would
50:26
be like in an imaginary healthcare environment
50:29
some years from now, where we and colleagues
50:31
have weathered the current crisis, and we've
50:34
come out feeling creative, robust, energetic,
50:37
excited, and committed to our work. In fact,
50:40
he described how he very often already feels
50:43
this way much of the time. And then he spoke
50:46
about the psychological safety of a work environment
50:49
in this imaginary world for most of us. So why
50:53
don't we do that thought experiment as an exercise
50:55
together right now? I think it's just to imagine
50:59
it's a few years from now. And whatever this
51:03
crisis means for you and your work environment,
51:06
you and your colleagues have weathered this quite
51:09
well. In fact, we've come out feeling energetic
51:11
and strong. motivated, inspired to do our work,
51:14
creative, even with the challenges that are inherent
51:17
in health care in general. So imagine this environment
51:22
may be quite different than the one that exists
51:25
right now, but this is sort of the fun of actually
51:28
thinking and imagining things that could be different.
51:33
And as you imagine yourself working in this environment,
51:36
energetic, robust, creative, how would you feel?
51:40
What would it be like for you to go to work?
51:42
in this environment what would your experience
51:44
of your work day be like i'm just taking for
51:48
taking a moment or two just to really check in
51:51
with yourself on what that may be like what would
51:56
others notice about you other members of your
51:59
team colleagues staff families patients what
52:04
would they notice about you in this imaginary
52:06
work environment what would they notice about
52:09
you And what would your colleagues, your teams,
52:13
your staff, what would they experience in this
52:16
environment with you? And finally, even though
52:21
this is an imaginary exercise, maybe there's
52:23
a way to start moving in that direction. Finally,
52:26
this question, what would you have had to learn
52:29
to practice in those several years between now
52:33
and that imaginary world to actually make it
52:36
happen? What would you have had to learn? So
52:41
you can practice this from time to time, even
52:43
very briefly, and perhaps take note of that final
52:45
question and then incorporate that maybe into
52:48
actions that you can consider making a commitment
52:52
to actually learn and practice what you need
52:55
in order to move into that future environment.
53:00
It may be closer than you think. I hope you found
53:04
this podcast and this simple exercise useful
53:07
to you. I look forward. to having you join us
53:10
for the next episode of Flourishing in Medicine
53:12
from Surviving to Thriving. You can learn more
53:16
about EmPRO by visiting www.myEmPRO.com or visiting
53:23
www.myEmPRO.com/peer-support
53:28
to hear about their peer support programs. If
53:33
you're a physician or a medical student and you
53:36
need urgent support, consider calling the physician
53:38
support line at 1 -888 -409 -0141. On the support
53:44
line you'll find safe space to discuss immediate
53:47
life stressors with a volunteer psychiatrist
53:50
colleague who is uniquely trained in mental wellness
53:55
with similar shared experiences as a health professional.
54:00
You want to find out more about me and my work?
54:03
visit www.MickKrasnermd.com or visit www.mindfulpracticeinmedicine.com
54:11
until then I'll see you next time