As a young man, I have always tried to be the one in charge. I have always wanted to be the smartest, strongest & right – I always wanted to be right. For the longest time, I have been that guy, not exposing my weaknesses, not exposing my uncertainties. I’m supposed to always know the right thing to do.
Well, thankfully, life ends up catching up with you & you cannot run from personal (emotional) development forever. For the last three years, a recurring theme has crept into my life – this theme of vulnerability. I would like to be all academic & fancy & say that it happened when I first heard about the patient safety movement & the no-blame culture. Yet, to be honest, it
started when I took leave. I was forced to face myself, in my own home, with my own dominating personality. I realised that I wasn’t a very nice person, even though I cared deeply. Why? I 
refused to expose my own uncertainties & my own vulnerabilities. I developed this intense desire to be authentic & cultivate connections 
with others. To do this, I had to be brave.
I read three books. The first was “The Art of Happiness” by the Dalai Lama who mentions that the secret to being happy is the human connection & being authentic within our dealings with others. The second book is by Amanada Palmer, called “The Art of Asking”. In her book, Palmer speaks about her journey with asking for help, & ceasing this endless desire of humans to go at it alone, & prove how wonderfully independent we are of everyone else. She speaks about exposing our own vulnerability & connecting with others. She has a fantastic TED Talk I would recommend watching.
The final book is based on the qualitative research by Brene Bworn, PhD (see her TED Talk here): Daring Greatly: How the courage to be vulnerable transforms the way we live, love, parent & lead.” This book has bowled me out completely. Brown speaks in her book about how our fear of being vulnerable & our fear of shame prevents us from innovation & connection. Any fear of failure translates to a fear of shame. She mentions that the first thing we look for in 
another individual is their vulnerability, which exposes their humanity & makes them approachable. The last thing we wish to display to others is our vulnerability. This “vulnerability is not knowing victory or defeat, it’s understanding the necessity of both; it’s engaging. And being all in.”
Our patients are no different in that they seek to see vulnerability (& humanity) in us. Except, our patients have no choice but to be vulnerable in front of us – they are in one of the worst situations, at our mercy – they have no choice but to be vulnerable. Perhaps, it’s a consequence of emergency medicine, perhaps a defence mechanism or perhaps our
inherent personalities, but our clinical demeanour protects us from our own vulnerability being exposed to patients & other clinicians. We hide behind a façade of jargon & blood results, failing to connect with the patient. Our patients are lost refugees, not understanding the system, with a foreign language all around them. They wish to feel safe, with humans who care. Show some humanity, some empathy.
Africa is vulnerable & our healthcare system is strained. We often have to make decisions based on the resources that we have available, despite knowing best evidence. Giving Rocuronium to one patient means not intubating another. However, Brown states that vulnerability is absolutely essential to innovation. Africa needs innovation & African Solutions to African Problems (#AS2AP).
The entire patient safety movement requires that we be vulnerable as healthcare providers. We are required to be honest about our mistakes & report them. In this leap of faith, we have no choice but to trust the inherent humanity of our clinical management teams & the system within which we report & function. Self-reporting requires us to be vulnerable too. If we do not have the courage to be vulnerable, self-reporting will not occur, & our patient safety initiatives will fail. Therefore, it requires bravery.
For my PhD, I am undertaking one of the first prehospital randomised controlled trials in Africa. I’m dreadfully afraid to fail at this because in my mind I would then automatically be seen as a failure myself. Sure there are people who may believe that I am a failure yet, knowledge will still be generated – even if it simply shows how not to do prehospital RCTs in Africa. My fear of failing at the RCT should not encourage me to not attempt it. Your fear of failing something shouldn’t either. In Africa, we need innovators who bravely take the plunge towards improvement. Be brave.
I have been invited to speak at the Swedish Society of Medicine in December, & decided to be frank about the problems in Africa & exposing our vulnerability – because sometimes we have no choice. Except, our vulnerability places us in the perfect position for innovation, & we have overcome so many difficulties because of this vulnerability. We can connect with many! I will showcase these initiatives. This is what I believe badEM is about – understanding & acknowledging our vulnerability, but using it towards patient connection, innovation & improved clinical care.
It’s okay to be scared & uncertain about a step or innovation. Don’t let this stifle your innovation. We need your braveness here!
Willem
