Medical Training Can Amplify Shame in Doctors, New Effort Aims to Build “Shame Competence”
A growing movement within medical education is focusing on addressing shame – both in physicians and how it impacts patient care – as research reveals the intense pressures of training can exacerbate the emotion and potentially harm doctor-patient relationships.
The distress began for Dr. Will Bynum, now an associate professor of family medicine at Duke University School of Medicine, during a residency shift when he utilized a vacuum device during an emergency delivery to save a baby’s life, but the mother suffered a severe tear requiring surgery. “I didn’t want to see anybody. I didn’t want anybody to find me,” Bynum said, describing the “primitive response” he had retreating to an empty hospital room. Researchers argue that without addressing shame, doctors may inadvertently transmit it to patients, potentially worsening their health outcomes. A study published in 2023 found that one-third of physicians reported feeling repulsed when treating patients with Type 2 diabetes, and nearly 40% viewed them as lazy.
The issue extends beyond the clinical setting, with some patients avoiding medical care altogether due to perceived judgment. Christa Reed, a Minneapolis-area wedding photographer, avoided doctors for two decades after being told her morning sickness during pregnancy was due to her weight. “Because going into a doctor for an annual visit would only just tell me to lose weight,” she stated. This avoidance led to a serious health crisis last year when a routine blood pressure check revealed dangerously high readings. The broader societal context is also a factor, as some officials have been criticized for blaming lifestyle choices for chronic conditions; for example, the FDA Commissioner recently suggested cooking classes could replace insulin treatment for some diabetes patients. You can learn more about the impact of weight stigma on healthcare at the Yale Medicine website.
Initiatives like “shame competence” training are emerging to help physicians recognize and manage shame in themselves and others. Dr. Savannah Woodward, a California psychiatrist, emphasizes the importance of human connection in medicine, noting that burnout and shame in doctors are palpable to patients. Duke University, in partnership with the University of Exeter in England through The Shame Lab, has begun offering this training to faculty and residents, building on a pilot program with OB-GYN residents. This effort is particularly important as medical training often involves intense scrutiny and a “masochistic” work ethic, according to Woodward, and can contribute to rates of depression and burnout among physicians – a growing concern within the Association of American Medical Colleges.
Bynum expressed regret that shame prevented him from checking on the mother after the delivery, and officials say the goal is to create a more supportive environment where physicians feel comfortable acknowledging vulnerability and seeking support.
