The feeling of shame overtook Will Bynum almost instantly during a critical moment in his medical career. As a second-year resident in family medicine, he was concluding a long shift when he was summoned for an emergency delivery. Utilizing a vacuum device to assist in the rapid delivery of the baby, Bynum successfully brought the newborn into the world unharmed. However, the mother endured a severe vaginal tear that necessitated surgical repair by an obstetrician. Following this distressing incident, Bynum found himself retreating to an empty hospital room, grappling with the feelings surrounding the unexpected complication. "I didn't want to see anybody. I didn't want anybody to find me," Bynum reflects, now an associate professor of family medicine at Duke University School of Medicine in North Carolina. This response illustrates the deeply ingrained nature of shame as a common and uncomfortable human emotion.
In the years that followed, Bynum emerged as a prominent advocate among clinicians and researchers, asserting that the intense demands of medical training can exacerbate feelings of shame in aspiring doctors. He is now actively involved in an innovative initiative aimed at teaching what he refers to as shame competence to medical students and practicing physicians alike. While Bynum acknowledges that shame cannot be entirely eradicated, he and his colleagues emphasize that incorporating related skills and practices can significantly diminish the pervasive culture of shame within the medical field. "Without this approach, tomorrow's doctors won't recognize and address the emotion in themselves and others," Bynum warns, highlighting the potential consequences of failing to manage shame effectively.
The implications of shaming extend beyond medical professionals to their patients, often leading to negative health outcomes. "Shaming patients can backfire," Bynum explains, noting that such approaches can provoke defensiveness and lead to social isolation or even substance use. This issue is compounded by a political climate where health officials have, at times, attributed chronic health issues, such as autism and diabetes, to the lifestyle choices of patients or their families. For instance, FDA Commissioner Marty Makary suggested in a Fox News interview that lifestyle changes, like cooking classes, could be more beneficial than simply prescribing insulin for diabetes. This attitude has been reflected in the attitudes of some physicians as well.
A 2023 study revealed that approximately one-third of physicians expressed feelings of repulsion while treating patients with Type 2 diabetes, which is often linked to obesity. Alarmingly, 44% of these physicians perceived their patients as lacking motivation to make lifestyle changes, while 39% regarded them as lazy. "We don't like feeling shame. We want to avoid it. It's very uncomfortable," states Michael Jaeb, a nurse at the University of Wisconsin-Madison who has conducted extensive reviews on this topic.
Many patients, like Christa Reed, have chosen to avoid medical care due to the shame they have experienced. For over two decades, Reed stayed away from regular medical check-ups, disillusioned by weight-related lectures she received during her pregnancies. "I was told when I was pregnant that my morning sickness was because I was a plus-size, overweight woman," she recalls. Despite facing urgent health issues, Reed avoided health care providers, believing that annual visits would yield nothing but more weight-related advice. However, a recent health scare prompted her to seek care again, leading to a positive experience with physicians who emphasized a supportive approach to health and nutrition.
Amid this backdrop, medical professionals like Savannah Woodward, a psychiatrist from California, are working to raise awareness about the damaging effects of shame within the healthcare system. Woodward co-led a session focused on the spiral of shame at the American Psychiatric Association's annual meeting, stressing the importance of acknowledging shame in healthcare providers. "If physicians don't recognize shame within themselves, they risk experiencing depression, burnout, and other complications that affect patient care," Woodward states.
Surveys conducted this year revealed that 37% of medical students reported feeling publicly embarrassed during their training, with nearly 20% experiencing public humiliation. The rigorous nature of medical education often fosters perfectionism and a demanding work ethic, leaving students vulnerable to feelings of inadequacy and shame. "You trip over your words. You miss things. You go blank," Bynum shares, elucidating the challenges faced by medical trainees. As these feelings fester, they can lead to debilitating thoughts about one’s competence and capabilities.
To combat this cycle, medical educators aim to help students recognize shame in themselves and others, thereby preventing its perpetuation. Karly Pippitt, a family medicine physician at the University of Utah, emphasizes the importance of reframing negative experiences. "If you felt shamed throughout your medical education, it normalizes that as the experience," she explains. Training initiatives, such as those launched by Bynum at Duke University, seek to instill shame competence in medical residents. The program, known as The Shame Lab, aims to reach a broader audience within the Duke Department of Family Medicine and Community Health.
More than a decade after that harrowing emergency delivery, Bynum continues to reflect on the shame that prevented him from checking on the mother after the delivery. "I was too scared of how she was going to react to me," he admits. A colleague later informed him that the mother had wished he had visited her, expressing gratitude 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," Bynum concludes, underscoring the profound need for compassion and understanding in the medical profession.
