‘Shame competence’ aims to break the cycle of blame in medicine : NPR

Grief, which Will Bynum later recognized as shame, overwhelmed him almost immediately.

Bynum, then in his second year of residency as a family medicine physician, was finishing a long shift when he was called to the emergency room. To save the baby's life, he used a vacuum device that uses suction to speed up labor.

The child came out unharmed. But the mother suffered a serious vaginal rupture, which required surgical intervention by an obstetrician. Soon after, Bynum retreated to an empty hospital room, trying to cope with his feelings about the unexpected complication.

“I didn’t want to see anyone. I didn't want anyone to find me,” Bynum said, now Associate Professor of the Department of Family Medicine at Duke University School of Medicine in North Carolina. “It was a really primitive response.”

Shame is a common and very uncomfortable human emotion. Over the years, Bynum has become leading voice among clinicians and researchers who argue that intensive medical training may increase feelings of shame in future doctors.

He is now part of a new effort to teach what he describes as “shame competence“For medical students and practicing doctors. Although shame cannot be eliminated, Bynum and his fellow researchers argue that appropriate skills and practices can reduce shame culture and promote healthier ways of dealing with it.

Without such an approach, they argue, doctors of tomorrow will not be able to recognize and address emotions in themselves and others. Thus, they risk transmitting the infection to their patients, even unintentionally, which may worsen your health. Patients' shame can backfire, making them defensive and leading to isolation and sometimes substance use, Bynum said.

Blame the patients

The political climate in the United States presents an additional obstacle to changing the culture of shame. Secretary of Health and Human Services Robert F. Kennedy Jr. and other senior Trump administration health officials publicly accused autism, diabetes, attention-deficit/hyperactivity disorder and other chronic problems that largely depend on the lifestyle of people with such diseases or their parents.

For example, FDA Commissioner Marty Macari suggested in an interview with Fox News that more diabetes could be treated with cooking classes rather than “I just throw insulin at people”

Even before the political changes, this attitude was reflected in doctors' offices. A 2023 study found that a third of doctors reported feeling disgusted in the treatment of patients with type 2 diabetes, which is associated with obesity. About 44% felt that these patients lacked motivation to make lifestyle changes, and 39% said they were prone to laziness.

“We don't like to feel shame. We want to avoid this. It’s very inconvenient,” he said. Michael Jebnurse from the University of Wisconsin-Madison with a reviewed related studies published in 2024. And if the source of shame is the doctor, the patient may ask, “Why should I come back?” In some cases, the patient can spread this throughout the health care system.”

Indeed, some patients, such as Christa Reed, have avoided doctors because of this. Reed gave up regular medical care for two decades, tired of lectures about weight. “When I was pregnant, I was told that my morning sickness was caused by being a plus-size, overweight woman,” she said.

With the exception of a few medical emergencies, such as an infected cut, Reed avoided medical services. “Because going to the doctor every year would be pointless,” said the now 45-year-old wedding photographer from Minneapolis. “They just told me to lose weight.”

Then, last year, severe jaw pain led Reed to seek specialized help. A routine blood pressure check showed sky-high readings, and she was sent to the emergency room. “They said, ‘We don’t know how you walk normally,’” she said.

Reed has since found support from doctors with nutrition expertise. 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.

“Masochistic” work ethic

Savannah Woodwardpsychiatrist in California, is part of a group of doctors trying to raise awareness of the harmful effects of shame and develop strategies to prevent and mitigate it. Although this work is in its early stages, she was one of the leading sessions on the shame spiral at the annual meeting of the American Psychiatric Association in May.

If doctors do not acknowledge their shame, they risk becoming depressed. burnoutdifficulty sleeping and other ripple effects that undermine patient care, she said.

“We don't often talk about how important human connections are in medicine,” Woodward said. “But if your doctor is burned out or feels like he doesn't deserve to be your doctor, patients feel it. They understand it.”

According to a survey conducted this year, 37% of graduates reported feeling publicly embarrassed at some point during medical school, and nearly 20% described being publicly humiliated, according to an annual survey by the Association of American Medical Colleges.

Medical students and residents are already prone to perfectionism, as well as an almost “masochistic” work ethic, as Woodward described it. They then face multiple exams and years of training, under constant supervision and with patients' lives on the line.

During training, doctors work in groups and give presentations to teachers about the patient's medical problems and the recommended approach to treatment. “You stumble over your words. You're missing something. You're ruining everything. You black out,” Bynum said. And then, he says, shame creeps in, leading to other debilitating thoughts such as: “I’m not good at this. I'm an idiot. Everyone around me would have done it much better.”

Still, shame remains “a crack in your armor that you don't want to show,” he said. Carly Pippittfamily physician at the University of Utah, who taught medical students about the possibility of shame as part of a broader course on ethics and the humanities.

“You care about human life,” she said. “Heaven forbid you behave as if you are not capable of anything, or show fear.”

Stop the Shame Cycle

The goal of teaching students about shame is to help future doctors recognize emotions in themselves and others so they don't perpetuate the cycle, Pippitt said. “If you've felt shame throughout your medical education, it becomes normalized as an experience,” she said.

Above all, trainee doctors can rethink their thinking when they receive a bad evaluation or have difficulty mastering a new skill, says Woodward, the California-based psychiatrist. Instead of believing that they failed as a physician, they can focus on where they went wrong and ways to improve.

Last year, Bynum began training Duke doctors in shaming skills, starting with about 20 OB-GYNs. This year he launched a larger initiative involving Laboratory of Shamea research and teaching partnership between Duke University and the University of Exeter in England, which he co-founded, to reach about 300 people in Duke's Department of Family Medicine and Public Health, including faculty and resident physicians.

This type of training is rare among Duke OB/GYNs. Kanice Dancelpeers in other programs. Having completed his training, Dancel now aims to support students in learning skills such as suturing. She hopes they will repay this approach with “a chain reaction of kindness to each other.”

More than a decade after Bynum experienced that stressful emergency birth, he still regrets that shame prevented him from visiting his mother as he usually did after the birth. “I was too afraid of how she would react to me,” he said.

“It was a little hurtful,” he said when a colleague later told him his mother would like him to come over. “She gave me a message to thank me for saving her child’s life. If I just gave myself a chance to hear that, it would really help me heal and be forgiven.”

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