{"id":2104282,"date":"2025-11-05T05:00:00","date_gmt":"2025-11-05T09:00:00","guid":{"rendered":"https:\/\/kffhealthnews.org\/?post_type=article&#038;p=2104282"},"modified":"2025-11-05T08:26:41","modified_gmt":"2025-11-05T13:26:41","slug":"shame-competence-medicine-doctor-training","status":"publish","type":"article","link":"https:\/\/kffhealthnews.org\/news\/article\/shame-competence-medicine-doctor-training\/","title":{"rendered":"While Politicos Dispense Blame, These Doctors Aim To Take Shame Out of Medicine"},"content":{"rendered":"\n<aside class=\"block--sidebar alignright \">\n\t\n\n<div class=\"wp-block-kaiser-health-news-partner block--partner\">\n\t\t\t\t\t\t<a class=\"partner__image--link\" href=\"http:\/\/www.npr.org\/sections\/news\/\">\n\t\t\t\t<img decoding=\"async\" class=\"partner__image\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2022\/07\/npr-hi-res-logo.png?w=120\" alt=\"Partner logo\" \/>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t<p class=\"partner__content\">\n\t\tThis story also ran on <a href=\"http:\/\/www.npr.org\/sections\/news\/https:\/\/www.npr.org\/2025\/10\/28\/nx-s1-5589220\/shame-competence-medicine-doctors-blame-patients\">NPR<\/a>. It can be <a href=\"https:\/\/kffhealthnews.org\/news\/article\/shame-competence-medicine-doctor-training\/view\/republish\/\">republished for free<\/a>.\t<\/p>\n<\/div>\n\n<\/aside>\n\n\n\n<p>The distress that Will Bynum later recognized as shame settled over him nearly immediately.<\/p>\n\n\n\n<p>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\u2019s life, he used a vacuum device, which applies suction to assist with rapid delivery.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>\u201cI didn\u2019t want to see anybody. I didn\u2019t want anybody to find me,\u201d said Bynum, now an <a><\/a><a href=\"https:\/\/fmch.duke.edu\/personnel\/will-bynum-md\">associate professor of family medicine<\/a> at Duke University School of Medicine in North Carolina. \u201cIt was a really primitive response.\u201d<\/p>\n\n\n\n<p>Shame is a common and highly uncomfortable human emotion. In the years since that pivotal incident, Bynum has become a <a href=\"https:\/\/journals.lww.com\/academicmedicine\/fulltext\/2025\/07000\/how_shame_shaped_me__exploring_the_impact_of_shame.17.aspx\">leading voice<\/a> among clinicians and researchers who argue that the intense crucible of medical training can amplify shame in future doctors.<\/p>\n\n\n\n<p>He is now part of an emerging effort to teach what he describes as \u201c<a href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(24)02269-4\/abstract\">shame competence<\/a>\u201d to medical school students and practicing physicians. While shame can\u2019t be eliminated, Bynum and his research colleagues maintain that related skills and practices can be developed to reduce the culture of shame and foster a healthier way to engage with it.<\/p>\n\n\n\n<p>Without this approach, they argue, tomorrow\u2019s doctors won\u2019t recognize and address the emotion in themselves and others. And thus, they risk transmitting it to their patients, even inadvertently, which may <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC7613638\/pdf\/JEP-28-854.pdf\">worsen their health<\/a>. Shaming patients can backfire, Bynum said, making them defensive and leading to isolation and sometimes substance use.<\/p>\n\n\n<div\n\tclass=\"wp-block block--newsletter  \"\n\tdata-type=\"kaiser-health-news\/newsletter\"\n\tdata-align=\"center\"\n\tstyle=\"\"\n>\n\t<h4 class=\"newsletter__title\">\n\t\t<a href=\"\/email\/\">\n\t\t\tEmail Sign-Up\t\t<\/a>\n\t<\/h4>\n\t<p class=\"newsletter__description\">\n\t\tSubscribe to KFF Health News&#039; free Morning Briefing.\t<\/p>\n\t\n<form\n\taction=\"\/email-signup\/\"\n\tclass=\"kaiser-hubspot-mini-signup-form\"\n\tmethod=\"post\"\n>\n\t<input type=\"hidden\" id=\"kaiser_hubspot_nonce\" name=\"kaiser_hubspot_nonce\" value=\"dc9818bd64\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/article\/2104282\" \/>\t\t\t\t<label\n\t\tclass=\"kaiser-hubspot-mini-signup-form__label--email\"\n\t\tfor=\"kaiser-hubspot-mini-signup-form-email\"\n\t>\n\t\t<span class=\"screen-reader-text\">\n\t\t\tYour Email Address\t\t<\/span>\n\t\t<input\n\t\t\tautocomplete=\"email\"\n\t\t\tclass=\"kaiser-hubspot-mini-signup-form__input--email\"\n\t\t\tid=\"kaiser-hubspot-mini-signup-form-email\"\n\t\t\tname=\"kaiser_hubspot_email\"\n\t\t\ttype=\"email\"\n\t\t\t\t\t\t\tplaceholder=\"Your email address\"\n\t\t\t\t\t\/>\n\t<\/label>\n\t<button class=\"kaiser-hubspot-mini-signup-form__submit\">\n\t\tSign Up\t<\/button>\n<\/form>\n<\/div>\n\n\n\n<p>The U.S. political environment presents an additional obstacle. Health and Human Services Secretary Robert F. Kennedy Jr. and other top Trump administration health officials have <a href=\"https:\/\/kffhealthnews.org\/news\/article\/maha-movement-chronically-ill-blame-game\/\">publicly blamed<\/a> autism, diabetes, attention-deficit\/hyperactivity disorder, and other chronic issues in large part on the lifestyle choices of people with the conditions \u2014 or their parents. For instance, FDA Commissioner Marty Makary suggested in a Fox News interview that diabetes could be better treated with cooking classes than \u201c<a href=\"https:\/\/www.thedailybeast.com\/robert-f-kennedy-jrs-fda-commissioner-marty-makarty-suggests-diabetics-get-cooking-classes-over-insulin\/\">just throwing insulin at people<\/a>.\u201d<\/p>\n\n\n\n<p>Even before the political shift, that attitude was reflected at doctors\u2019 offices as well. A 2023 study found that <a href=\"https:\/\/www.diabetesresearchclinicalpractice.com\/article\/S0168-8227(23)00590-9\/abstract\">one-third of physicians reported feeling repulsed<\/a> when treating patients with Type 2 diabetes. About 44% viewed those patients as lacking motivation to make lifestyle changes, while 39% said they tended to be lazy.<\/p>\n\n\n\n<p>\u201cWe don\u2019t like feeling shame. We want to avoid it. It\u2019s very uncomfortable,\u201d said <a href=\"https:\/\/www.fammed.wisc.edu\/directory\/9cc3f9cc\/\">Michael Jaeb<\/a>, a nurse at the University of Wisconsin-Madison, who has <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/38500241\/\">conducted a review<\/a> of related studies, published in 2024. And if the source of shame is from the clinician, the patient may ask, \u201c\u2018Why would I go back?\u2019 In some cases, that patient may generalize that to the whole health care system.\u201d<\/p>\n\n\n\n<p>Indeed, Christa Reed dropped out of regular medical care for two decades, weary of weight-related lectures. \u201cI was told when I was pregnant that my morning sickness was because I was a plus-size, overweight woman,\u201d she said.<\/p>\n\n\n\n<p>Except for a few urgent medical issues, such as an infected cut, Reed avoided health care providers. \u201cBecause going into a doctor for an annual visit would be pointless,\u201d said the now 45-year-old Minneapolis-area wedding photographer. \u201cThey would only just tell me to lose weight.\u201d<\/p>\n\n\n\n<p>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. \u201cThey said, \u2018We don\u2019t know how you\u2019re walking around normal,\u2019\u201d she recounted.<\/p>\n\n\n\n<p>Since then, Reed has found supportive physicians with expertise in nutrition. Her blood pressure remains under control with medication. She\u2019s also nearly 100 pounds below her heaviest weight, and she hikes, bikes, and lifts weights to build muscle.<\/p>\n\n\n\n<p><a href=\"https:\/\/providerwire.com\/psychiatry-physician\/california\/camp-pendleton\/savannah-woodward-1063946721\">Savannah Woodward<\/a>, 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\u2019s annual meeting in May. <\/p>\n\n\n\n<p>If physicians don\u2019t acknowledge shame in themselves, they can be at risk of depression, <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S1931720425000285?via%3Dihub\">burnout<\/a>, sleeping difficulties, and other ripple effects that erode patient care, she said.<\/p>\n\n\n\n<p>\u201cWe often don\u2019t talk about how important the human connection is in medicine,\u201d Woodward said. \u201cBut if your doctor is burned out or feeling like they don\u2019t deserve to be your doctor, patients feel that. They can tell.\u201d<\/p>\n\n\n\n<p>In a survey conducted this year, 37% of graduating students <a href=\"https:\/\/www.aamc.org\/data-reports\/students-residents\/report\/graduation-questionnaire-gq\">reported feeling publicly embarrassed<\/a> at some point in medical school. And nearly 20% described public humiliation, according to the annual survey by the Association of American Medical Colleges.<\/p>\n\n\n\n<p>Medical students and resident physicians are already prone to perfectionism, along with an almost \u201cmasochistic\u201d work ethic, as Woodward described it. Then they\u2019re run through a gantlet of exams and years of training, amid constant scrutiny and with patients\u2019 lives on the line.<\/p>\n\n\n\n<p>During training, physicians work in teams and make presentations to teaching faculty about a patient\u2019s medical issues and their recommended treatment approach. \u201cYou trip over your words. You miss things. You get things out of order. You go blank,\u201d Bynum said. And then shame creeps in, he said, leading to other debilitating thoughts, such as \u201c\u2018I\u2019m no good at this. I\u2019m an idiot. Everyone around me would have done this so much better.\u2019\u201d<\/p>\n\n\n\n<p>Yet shame remains \u201ca crack in your armor that you don\u2019t want to show,\u201d said <a href=\"https:\/\/healthcare.utah.edu\/find-a-doctor\/karly-ann-pippitt\">Karly Pippitt<\/a>, 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.<\/p>\n\n\n\n<p>\u201cYou\u2019re taking care of a human life,\u201d she said. \u201cHeaven forbid that you act like you\u2019re not capable or you show fear.\u201d<\/p>\n\n\n\n<p>When students are taught about shame, the goal is to help future physicians recognize the emotion in themselves and others, so they don\u2019t perpetuate the cycle, Pippitt said. \u201cIf you felt shamed throughout your medical education, it normalizes that as the experience,\u201d she said.<\/p>\n\n\n\n<p>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\u2019ve failed as a physician, they can focus on what they got wrong and ways to improve.<\/p>\n\n\n\n<p>Last year, Bynum started teaching Duke physicians about shame competence, beginning with roughly 20 OB-GYN residents. This year, he launched a larger initiative with <a href=\"https:\/\/www.shamelab.org\/home\">The Shame Lab<\/a>, 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\u2019s Department of Family Medicine and Community Health, including faculty and residents.<\/p>\n\n\n\n<p>This sort of training is rare among Duke OB-GYN resident <a href=\"https:\/\/obgyn.duke.edu\/personnel\/canice-dancel-md\">Canice Dancel<\/a>\u2019s 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 \u201ca chain reaction of being kind to each other.\u201d<\/p>\n\n\n\n<p>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. \u201cI was too scared of how she was going to react to me,\u201d he said.<\/p>\n\n\n\n<p>\u201cIt was a little devastating,\u201d he said, when a colleague later told him that the mother wished he had stopped by. \u201cShe had passed a message along to thank me for saving her baby\u2019s life. If I had just given myself a chance to hear that, that would have really helped in my recovery, to be forgiven.\u201d<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Clinicians and researchers are starting to embrace an effort to develop what\u2019s known as \u201cshame competence\u201d in physicians to combat burnout and prevent that uncomfortable emotion from being passed along to patients.<\/p>\n","protected":false},"featured_media":2106398,"template":"","meta":{"_cr_original_post":"","_cr_replace_post_id":"","_cr_replacing_post_id":"","jetpack_post_was_ever_published":false,"kff_featured_video":0,"kff_show_featured_video":false,"kff_show_mute_audio_button":false,"custom_shortlink":"\/MjEwNDI4Mg","kaiser_health_news_byline_override":"","kaiser_health_news_can_republish":true,"kaiser_health_news_featured_image_caption":"","kaiser_health_news_header_overlay_color":"","kaiser_health_news_header_theme_slug":"","kaiser_health_news_hero_image":0,"kaiser_health_news_backdrop_padding":115,"kaiser_health_news_hide_partner":false,"kaiser_health_news_kicker":"","kaiser_health_news_kicker_background_color":"","kaiser_health_news_kicker_text_color":"","kaiser_health_news_kicker_url":"","kaiser_health_news_nav_theme_slug":"compact","kaiser_health_news_nav_transparency":false,"kaiser_health_news_sharing_title":"","kaiser_health_news_show_featured_image":true,"kaiser_health_news_subheadline":"","kaiser_health_news_suppress_kicker":false,"kaiser_health_news_suppress_subheadline":false,"kaiser_health_news_update_time":"","kaiser_health_news_vertical_image":0,"kaiser_health_news_title_align_left":false,"kaiser_health_news_custom_header_image":0,"photo_byline":[],"story_update":"","update_position":"bottom","kaiser_syndication_sites":[],"apple_news_api_created_at":"2025-11-05T10:04:37Z","apple_news_api_id":"f403ce67-c588-4e8a-b6f5-dd7d45989523","apple_news_api_modified_at":"2025-11-05T13:26:40Z","apple_news_api_revision":"AAAAAAAAAAAAAAAAAAAAAA==","apple_news_api_share_url":"https:\/\/apple.news\/A9APOZ8WIToq29d19RZiVIw","apple_news_cover_media_provider":"image","apple_news_coverimage":0,"apple_news_coverimage_caption":"","apple_news_cover_video_id":0,"apple_news_cover_video_url":"","apple_news_cover_embedwebvideo_url":"","apple_news_is_hidden":"","apple_news_is_paid":"","apple_news_is_preview":"","apple_news_is_sponsored":"","apple_news_maturity_rating":"","apple_news_metadata":"\"\"","apple_news_pullquote":"","apple_news_pullquote_position":"","apple_news_slug":"","apple_news_sections":["https:\/\/news-api.apple.com\/sections\/20265c01-23d7-4d15-96e0-0691b89c3772"],"apple_news_suppress_video_url":false,"apple_news_use_image_component":false,"footnotes":""},"categories":[178379,5004,439525647,439528530,36835],"tags":[439530183,303251306,58401,303277465,345392,19886,20037,303195282,439524171,439530314],"primary-topic":[],"partners":[439524320],"funder":[439525512,439528750],"coauthors":[439524236],"class_list":["post-2104282","article","type-article","status-publish","has-post-thumbnail","hentry","category-health-industry","category-mental-health","category-midwest-bureau","category-southern-bureau","category-syndicate","tag-agency-watch","tag-chronic-disease-care","tag-doctors","tag-hhs","tag-medical-education","tag-minnesota","tag-north-carolina","tag-nurses","tag-trump-administration","tag-workforce","partners-npr","funder-missouri-foundation-for-health","funder-robert-wood-johnson-foundation"],"apple_news_notices":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.9 - 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