By When Dr. Will Bynum recalls a pivotal moment from his medical residency, he remembers not triumph but anguish — a sudden wave of humiliation that would change how he thought about medicine.
During his second year of family medicine residency, Bynum was called into an emergency delivery after a grueling shift. To save the newborn’s life, he used a vacuum device to assist with the birth. The baby was healthy, but the mother sustained a severe vaginal tear that required surgical repair.
Though the outcome was medically sound, Bynum felt devastated. He retreated to an empty hospital room, overwhelmed and ashamed. “I had no desire to see anyone. I didn’t want anybody to find me,” recalled Bynum, now an assistant professor of family medicine at Duke University School of Medicine. “It was a really primitive response.”
That moment marked the beginning of his work to understand shame — one of the most painful yet least discussed emotions in the field of medicine. Today, Bynum is a leading advocate for what he calls “shame competence” — helping doctors and medical students recognize, manage, and move through shame rather than be controlled by it.
Teaching “Shame Competence” in Medicine
Bynum and his colleagues argue that medical education often amplifies shame through perfectionism, relentless evaluation, and emotional suppression. Their research suggests that understanding shame is not just a matter of personal resilience but of public health: doctors who internalize shame may unknowingly pass it on to their patients.
“Without this awareness,” Bynum explained, “future physicians may struggle to identify and manage emotions — both their own and their patients’. That can lead to unintended harm.”
When patients feel shamed by their doctors, they often respond defensively, avoid follow-ups, or even turn to self-destructive coping mechanisms such as substance use. “Shaming patients can backfire,” Bynum noted. “It can isolate them — and sometimes, it makes them sicker.”
The Culture of Blame in American Healthcare
Changing the culture of shame in medicine isn’t easy — especially in a political environment that often blames individuals for their illnesses. Some U.S. officials have publicly linked conditions like autism, diabetes, ADHD, and obesity to personal or parental “lifestyle choices.”
In one interview, FDA Commissioner Marty Makary even suggested that “cooking lessons” could replace insulin for diabetes management — a mindset that oversimplifies complex health issues.
Such attitudes persist in clinical settings. A 2023 study found that one-third of doctors treating patients with Type 2 diabetes — often associated with obesity — reported feeling disgust toward those patients. Nearly 39% described them as lazy, and 44% believed they lacked motivation to change.
“We dislike feeling ashamed — it’s deeply uncomfortable,” said Michael Jaeb, a nurse and researcher at the University of Wisconsin–Madison who published a review on shame in healthcare in 2024. “If the doctor is the source of that shame, the patient may think, ‘Why would I go back?’ Sometimes, they generalize that feeling to the entire healthcare system.”
When Shame Keeps Patients Away
That’s exactly what happened to Christa Reed, a 45-year-old wedding photographer from Minnesota. After repeated lectures about her weight, Reed stopped seeing doctors for two decades. “I was told during pregnancy that my morning sickness was because I was a plus-size woman,” she recalled.
Except for serious issues like infections, she avoided medical care entirely. “There was no point,” she said. “They would just tell me to lose weight.”
When severe jaw pain finally brought her to a specialist last year, a routine blood pressure check revealed dangerously high numbers. “They said, ‘We don’t know how you’re even walking around,’” she recalled.
Reed eventually found supportive physicians who focused on her nutrition and long-term health. With medication including Ozempic, her blood pressure is under control. She now cycles, hikes, lifts weights — and has lost more than 100 pounds from her highest weight.
The “Masochistic” Culture of Medical Training
Doctors themselves aren’t immune to shame. Dr. Savannah Woodward, a California psychiatrist, is part of a growing group of physicians raising awareness about how shame damages both clinicians and their patients.
At the American Psychiatric Association’s 2024 annual meeting, Woodward co-led a session titled The Spiral of Shame, addressing how perfectionism and guilt erode mental well-being in medicine. “Physicians who don’t process their guilt risk depression, fatigue, and burnout,” she said. “And patients can sense when their doctor feels unworthy or disconnected.”
According to the Association of American Medical Colleges, 37% of graduating medical students report being publicly humiliated at some point during their training, while nearly 20% say they’ve been publicly embarrassed.
Medical training’s relentless scrutiny only worsens this. “You stumble, you forget, you go blank — and suddenly you’re telling yourself, ‘I’m not good at this,’” said Bynum. “Those thoughts spiral quickly into shame.”
Dr. Karly Pippitt, a family medicine physician at the University of Utah, teaches about shame as part of her school’s ethics and humanities curriculum. “You’re caring for human life,” she said. “Heaven forbid you show fear or imperfection.”
Breaking the Cycle
Pippitt’s goal — like Bynum’s — is to help medical students recognize shame in themselves and others so they can stop perpetuating it. “If you were shamed during your training, it normalizes that experience,” she said. “You may unknowingly pass it on to others.”
Woodward agrees that reframing is crucial. When trainees receive a poor evaluation or struggle with a new skill, she advises them to shift perspective: instead of viewing it as failure, ask what went wrong, and how can I do better next time?
Last year, Bynum began formally teaching shame competence at Duke University. His first pilot program trained about 20 OB-GYN residents. This year, he expanded the initiative through The Shame Lab, a collaboration between Duke University and the University of Exeter in England, to reach roughly 300 medical staff and residents across Duke’s Department of Family Medicine and Community Health.
Among them is Dr. Canice Dancel, who now mentors students learning hands-on skills like surgical suturing. She hopes the approach spreads — “a chain reaction of being kind to each other,” she said.
A Lesson Learned
More than a decade after that emergency delivery, Bynum still remembers the mother whose life he helped save — and the guilt that kept him from visiting her afterward. “I was too scared of how she would react,” he said.
Later, he learned she had sent him a note of gratitude for saving her child’s life. “It was a little devastating,” he admitted. “If I’d given myself the chance to hear her words, I would have healed much faster.”
For Bynum and a growing number of physicians, that’s the point: shame will always exist in medicine, but it doesn’t have to define it.
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