CENTRAL  SOUTH  DAKOTA  MEDICAL NEWS
THE CLINICAL VIEW
By: Phillip E. Hoffsten, M.D.
26  JULY  2001

The Blame Game

In previous columns I have discussed scientific studies showing that certain qualities of a personality are associated with negative health consequences. One of these personal qualities was described as "angry all the time".  Another is a pessimistic person who rarely sees the benefit or good in a situation. People with these personality traits are often very adept at something called the blame game.

The game goes like this. Many years ago when I was still in training, a young man came to the emergency room with an acute appendicitis. The young man's mother was very upset because her son was sick and she did not know what was wrong or how to fix it. The receptionist who greeted her had already had a long day and was not ready to deal with the mother's anxiety so there was a sharp unpleasant exchange at the reception desk before the young man was ever seen by medical personnel. The nurse who brought the young man back to the examining room noted the mother's anxiety and warned the doctor whom I, as a student, was following. The doctor was in no mood to deal with an anxious demanding mother and brushed off the young boy's complaints as "a little indigestion". The mother was told to feed the young man chicken soup, wait a few days, and they were shooed out the door. As a student at that time, I thought to myself that this just did not look right but medical students frequently do best by being very quiet. Hours later, the mother and young man returned and the appropriate diagnosis of appendicitis was made. Unfortunately, the young man's appendix ruptured and he had a prolonged hospital stay before recovery. I remember being at the review conference where medical complications are discussed. It was a perfect example of the blame game. Both the doctor and the nurse who had first cared for the young man were present at the conference. The doctor blamed the nurse for not alerting him that this appeared to be a very sick child. The nurse blamed the receptionist for "antagonizing" the mother. The receptionist was reprimanded at a later time and blamed the young man's mother for being so antagonistic. If the truth be known, all four individuals contributed to a very unfortunate outcome yet no one was willing to acknowledge that they were part of the problem. Thus, the blame game becomes a basic defense mechanism whereby a person avoids responsibility for an adverse outcome. If another person can be blamed for the problem then the blaming individual does not need to be wrong and then the blaming individual does not need to change their behavior and most importantly does not have to be punished. Therein lies the root of the whole problem.

In families, working situations or interactions with customers or friends, the blame game is intensely destructive. The blaming person is angry to begin with and creates anger in the person blamed. The situation usually deteriorates from there. Hoffsten's Rule #5 states: "It is not wrong to be wrong. It is just wrong to stay wrong." Anybody playing the blame game is staying wrong and violating that rule. Adverse events and less than desirable results are a fact of life. They result from miscues, misinterpretations, oversights and a host of other human foibles we all have. But blaming does not solve the problem.

Rather the correct approach is to ask, "What do we need to do to correct the problem?" With this question comes an answer which leads to corrective steps. It avoids concepts of retribution and punishment and fault. Most importantly, it avoids the extreme destruction of intrapersonal relationships that result from the blame game. Instead of asking, "Who did this?", the question needs to become, "How did this happen?". Instead of asking, "Who do we blame for this?", the questions needs to be, "How can we make a correction that will avoid this problem in the future?" Then people begin to think together in a constructive manner rather than making one individual wrong and trying to conceive an appropriate "punishment" for what is most often an honest mistake, a misinterpretation or an act based upon misinformation.

The most important rule in the blame game is don't play it. Don't start the game yourself and don't get hooked when someone starts blaming you. Not playing the game avoids problems with anger and depression with their associated severe adverse health consequences. Be constructive and corrective, not blaming and punitive.