Bowman Deborah
Med Humanit. 2017 Dec;43(4):264-268. doi: 10.1136/medhum-2017-011354. Epub 2017 Oct 27.
Shame in healthcare remains relatively underexplored, yet it is commonplace and its impact is significant. This paper explores shame in healthcare using Nina Raine's 2011 play Three manifestations of shame are explored, namely (1) shame in relation to professional identity and survival in the clinical workplace; (2) shame and illness as experienced by both patients and doctors; and (3) the systemic and organisational influences on shame within healthcare systems. I suggest that the theatre is particularly well-placed to elucidate shame, and that demonstrates the prevalence and impact of shame on clinical work. Shame has a fundamental and overlooked relationship with damaging and well-documented phenomena in healthcare, including moral distress, ethical erosion, compassion fatigue, burnout, stress and ill health. Attention to shame is essential for those interested in medicine and healthcare and must, I propose, include the experiences and perceptions of those who provide care, as well as attending to those who receive care.
医疗保健领域中的羞耻感相对而言仍未得到充分探讨,然而它却很常见且影响重大。本文运用尼娜·雷恩2011年的戏剧作品探讨医疗保健领域中的羞耻感。探讨了羞耻感的三种表现形式,即:(1)与临床工作场所中的职业身份和生存相关的羞耻感;(2)患者和医生所体验到的羞耻感与疾病;以及(3)医疗保健系统中对羞耻感的系统性和组织性影响。我认为戏剧特别适合用来阐明羞耻感,并且它展示了羞耻感在临床工作中的普遍性和影响。羞耻感与医疗保健中具有破坏性且有充分记录的现象有着根本且被忽视的关系,这些现象包括道德困扰、道德侵蚀、同情疲劳、职业倦怠、压力和健康不佳。对于那些对医学和医疗保健感兴趣的人来说,关注羞耻感至关重要,而且我认为必须包括提供护理者的经历和看法,同时也要关注接受护理者。