During the pandemic, an elderly male doctor is very tired from work, he sits at his desk in the resident’s office and holds his head.
fpphotobank/iStockphoto/Getty Images
hide caption
toggle caption
fpphotobank/iStockphoto/Getty Images
The distress that Will Bynum later recognized as shame settled over him nearly immediately.
Bynum, then in his second year of residency training as a family medicine physician, was wrapping up a long shift when he was called into an emergency delivery. To save the baby’s life, he used a vacuum device, which applies suction to assist with rapid delivery.
The baby emerged unharmed. But the mother suffered a severe vaginal tear that required surgical repair by an obstetrician. Soon afterward, Bynum retreated to an empty hospital room, trying to process his feelings about the unexpected complication.
“I didn’t want to see anybody. I didn’t want anybody to find me,” said Bynum, now an associate professor of family medicine at Duke University School of Medicine in North Carolina. “It was a really primitive response.”
Shame is a common and highly uncomfortable human emotion. In the years since, Bynum has become a leading voice among clinicians and researchers who argue that the intense crucible of medical training can amplify shame in future doctors.
He is now part of an emerging effort to teach what he describes as “shame competence” to medical school students and practicing physicians. While shame can’t be eliminated, Bynum and his research colleagues maintain that related skills and practices can reduce the culture of shame and foster a healthier way to engage with it.
Without this approach, they argue, tomorrow’s doctors won’t recognize and address the emotion in themselves and others. And thus, they risk transmitting it to their patients, even inadvertently, which may worsen their health. Shaming patients can backfire, Bynum said, making them defensive and leading to isolation and sometimes substance use.
Blame the patients
The U.S. political environment presents an additional obstacle to changing the culture of shame. Health and Human Services Secretary Robert F. Kennedy Jr. and other top Trump administration health officials have publicly blamed autism, diabetes, attention-deficit/hyperactivity disorder, and other chronic issues in large part on the lifestyle choices of people with the conditions — or their parents.
For instance, FDA Commissioner Marty Makary suggested in a Fox News interview that more diabetes could be treated with cooking classes instead of “just throwing insulin at people.”
Even before the political shift, that attitude was reflected at doctors’ offices as well. A 2023 study found that one-third of physicians reported feeling repulsed when treating patients with Type 2 diabetes, which is sometimes linked to obesity. About 44% viewed those patients as lacking motivation to make lifestyle changes, while 39% said they tended to be lazy.
“We don’t like feeling shame. We want to avoid it. It’s very uncomfortable,” said Michael Jaeb, a nurse at the University of Wisconsin-Madison, who has conducted a review of related studies, published in 2024. And if the source of shame is from the clinician, the patient may ask, “‘Why would I go back?’ In some cases, that patient may generalize that to the whole health care system.”
Indeed, some patients, like Christa Reed have avoided doctors because of this. Reed dropped out of regular medical care for two decades, weary of weight-related lectures. “I was told when I was pregnant that my morning sickness was because I was a plus-size, overweight woman,” she said.
Except for a few urgent medical issues, such as an infected cut, Reed avoided health care providers. “Because going into a doctor for an annual visit would be pointless,” said the now 45-year-old Minneapolis-area wedding photographer. “They would only just tell me to lose weight.”
Then, last year, severe jaw pain drove Reed to seek specialty care. A routine blood pressure check showed a sky-high reading, sending her to the emergency room. “They said, ‘We don’t know how you’re walking around normal,'” she recounted.
Since then, Reed has found supportive physicians with expertise in nutrition. Her blood pressure remains under control with medication. She’s also nearly 100 pounds below her heaviest weight, and she hikes, bikes, and lifts weights to build muscle.
A “masochistic” work ethic
Savannah Woodward, a California psychiatrist, is among a group of physicians trying to bring attention to the detrimental effects of shame and develop strategies to prevent and mitigate it. While this effort is in the early stages, she co-led a session on the spiral of shame at the American Psychiatric Association’s annual meeting in May.
If physicians don’t acknowledge shame in themselves, they can risk depression, burnout, sleeping difficulties, and other ripple effects that erode patient care, she said.
“We often don’t talk about how important the human connection is in medicine,” Woodward said. “But if your doctor is burned out or feeling like they don’t deserve to be your doctor, patients feel that. They can tell.”
In a survey conducted this year, 37% of graduating students reported feeling publicly embarrassed at some point in medical school, and nearly 20% described public humiliation, according to an annual survey by the Association of American Medical Colleges.
Medical students and physician residents are already prone to perfectionism, along with an almost “masochistic” work ethic, as Woodward described it. Then they’re run a gantlet of exams and years of training, amid constant scrutiny and with patients’ lives on the line.
During training, physicians work in teams and make presentations to teaching faculty about a patient’s medical issues and their recommended treatment approach. “You trip over your words. You miss things. You get things out of order. You go blank,” Bynum said. And then shame creeps in, he said, leading to other debilitating thoughts, such as “‘I’m no good at this. I’m an idiot. Everyone around me would have done this so much better.'”
Yet shame remains “a crack in your armor, that you don’t want to show,” said Karly Pippitt, a family medicine physician at the University of Utah who has taught medical students about the potential for shame as part of a broader ethics and humanities course.
“You’re taking care of a human life,” she said. “Heaven forbid that you act like you’re not capable or you show fear.”
Stop the shame cycle
When teaching students about shame, the goal is to help future physicians recognize the emotion in themselves and others, so they don’t perpetuate the cycle, Pippitt said. “If you felt shamed throughout your medical education, it normalizes that as the experience,” she said.
Above all, physicians-in-training can work to reframe their mindset when they receive a poor grade or struggle to master a new skill, said Woodward, the California psychiatrist. Instead of believing that they’ve failed as a physician, they can focus on what they got wrong and ways to improve.
Last year, Bynum started teaching Duke physicians about shame competence, beginning with roughly 20 OB-GYN physician residents. This year, he launched a larger initiative with The Shame Lab, a research and training partnership between Duke University and the University of Exeter in England that he co-founded, to reach about 300 people across Duke’s Department of Family Medicine and Community Health, including faculty and physician residents.
This sort of training is rare among Duke OB-GYN resident Canice Dancel‘s peers in other programs. Dancel, who completed the training, now strives to support students as they learn skills such as how to suture. She hopes they will pay that approach forward in “a chain reaction of being kind to each other.”
More than a decade after Bynum experienced that stressful emergency delivery, he still regrets that shame kept him from checking on the mother as he usually would following delivery. “I was too scared of how she was going to react to me,” he said.
“It was a little devastating,” he said, when a colleague later told him that the mother wished he had stopped by. “She had passed a message along to thank me for saving her baby’s life. If I had just given myself a chance to hear that, that would have really helped in my recovery, to be forgiven.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF.
