Shame is a difficult topic for many in medicine, but it profoundly affects how we view ourselves, interact with patients, and perform under pressure. Left unaddressed, shame can undermine our professional competence and well-being. In this blog post, we’ll explore how shame manifests in medical training and how developing “shame competence” can help all providers—whether you’re a medical student, resident, or attending—become more resilient and compassionate. We’ll discuss why shame is so pervasive in healthcare, how it becomes internalized, and practical steps you can take to build shame competence in your daily practice.
Understanding Shame in Healthcare
In healthcare, shame is a powerful, often hidden emotion that can influence both personal well-being and professional performance. To navigate it effectively, it’s crucial to understand how it differs from guilt and why it’s particularly potent in medical settings. In this section, we’ll break down the unique role shame plays in medicine and explore how it can impact us as individuals and providers.
Defining Shame vs. Guilt
A critical first step is recognizing that shame and guilt are not the same emotion. Guilt is about a behavior—”I did something bad”—whereas shame is about identity—”I am bad.” Shame runs deeper: it strikes at the core of who we are as people and as professionals. According to Dr. Will Bynum, an associate professor of family medicine at Duke University,
“Shame often feels very destabilizing. It’s hard to restabilize when you feel fundamentally wrong, or fundamentally flawed or broken in some way.”
When we make mistakes or fall short of expectations in a medical setting, shame can quickly become pervasive, making us feel “fundamentally wrong” rather than simply someone who erred.
Why Shame Is Uniquely Potent in Medical Settings
Medicine is high-stakes work. Our decisions directly affect patient outcomes, which means that perceived failure or errors can feel catastrophic. Compounding this, healthcare culture often emphasizes perfectionism: “do no harm,” meet exacting performance metrics, maintain a confident bedside manner. For many physicians, being a doctor becomes a core identity—so any shortcoming can feel all-consuming and deeply personal. This combination of high stakes and identity entanglement intensifies the impact of shame.
The Spectrum of Shame
Shame isn’t always a dramatic, life-altering emotion. It can range from a fleeting pang of discomfort to a prolonged sense of self-doubt. In small doses, it can motivate change or ethical introspection. However, repeated exposure—especially when unaddressed—can accumulate until shame becomes chronic, shaping how we view our worth both personally and professionally.
Dr. Will Bynum’s Journey: A Personal Illustration
Dr. Bynum’s personal experience as a resident offers a powerful example of how shame can emerge from medical mistakes. His story illustrates not only the emotional fallout of an error but also the path to healing through empathy and self-reflection.
Making a Medical Error
Dr. Bynum recalls an emergency scenario in which he had to deliver a baby quickly:
“I delivered the baby and saved the baby, thank God… but in the process of delivering, I caused a very, very severe maternal injury.”
Despite the baby being saved, the severe maternal injury weighed heavily on him. This single moment altered how he saw himself—no longer just a doctor who made a mistake, but someone who felt fundamentally unworthy.
Immediate Emotional Fallout
In the aftermath, Dr. Bynum experienced the classic “fight-or-flight” response. He wanted to hide, withdraw, and avoid facing the gravity of his mistake. As he describes,
“I just wanted the ground to open and swallow me up.”
This visceral reaction underscores how potent shame can be, often driving medical professionals to isolate themselves rather than seek help or counsel.
Road to Recovery
A single colleague’s empathy proved crucial for Dr. Bynum. A midwife reached out to him to provide reassurance, demonstrating the life-altering power of compassionate support. Eventually, he gained the courage to confide in a trusted friend, who helped him process and contextualize the event—thereby allowing him to see it as one moment in a long career, rather than a defining personal failing. Dr. Bynum also encountered Brené Brown’s work on shame, which gave him a vocabulary for what he was feeling. Naming shame is a transformative step—it demystifies the emotion and paves the way for healthier coping strategies.
Shame Competence: A Framework for Transforming Vulnerability
Dr. Bynum and his colleague Luna Dolezal, a philosopher, have conceptualized “shame competence” as a set of practical skills to engage with shame constructively. As Dr. Bynum says:
“Shame competence is essentially a set of skills, practices, and principles that can be learned and applied to support and facilitate constructive engagement with shame in a way that mitigates its destructive potential and leverages its prosocial potential.”
These principles can help doctors navigate the powerful emotional currents of shame so that it no longer paralyzes or isolates them.
Core Elements of Shame Competence
To build shame competence, it’s important to cultivate specific skills and practices that help manage and mitigate the impact of shame. These core elements, grounded in research on shame resilience, are key to fostering emotional well-being and professional growth in medical practice:
- Recognition & Labeling: Learning to identify shame’s triggers and recognize its physical and emotional cues (e.g., a flushed face, racing heart, or a desire to withdraw) is crucial. Acknowledging these signals allows us to address shame before it spirals into self-criticism or avoidance.
- Normalization: Shame is a universal, human emotion. Experiencing shame doesn’t imply weakness or unfitness for medicine—it signals a deep investment in the work and a desire to meet the high standards of patient care.
- Healthy Self-Evaluation: It’s important to separate actions from identity. A medical error is an isolated event—a behavior—rather than a reflection of personal worth. This distinction allows for growth and learning without the internalization of failure.
- Interpersonal Support: Shame thrives in secrecy and isolation. Fostering open communication, peer support, and safe spaces within the medical community helps break the silence and reminds individuals that no one is immune to mistakes or emotional struggles.
- Organizational Structures: Institutions can support shame competence by creating systems that promote transparency, encourage debriefing sessions, implement peer support programs, and adopt policies that allow open discussions of errors without fear of punitive consequences.
The Collective Nature of Shame & Shame Competence
It’s important to remember that shame doesn’t exist in a vacuum. Our interactions with each other, the expectations of our leadership, and the broader culture of medicine all shape and perpetuate shame. Shame competence involves addressing these multiple layers—personal, interpersonal, and institutional—to create a culture where vulnerability is not met with criticism or stigma.
Practical Strategies to Foster Shame Competence in Medical Training
Fostering shame competence in medical training requires a multifaceted approach that involves both individual and systemic strategies. In this section, we’ll explore practical strategies to develop resilience and emotional well-being—empowering healthcare professionals to manage shame in healthier, more constructive ways.
Creating a Shared Language Around Shame
Workshops, seminars, and reflection rounds where trainees learn to discuss shame openly can help normalize this conversation. When there’s a shared vocabulary, it becomes easier to identify and navigate the emotion before it becomes destructive.
Building Supportive Peer & Mentor Relationships
An empathetic colleague can make all the difference. As Dr. Bynum’s experience illustrates, having someone reach out during our lowest moments can feel like a lifeline. Formal mentorship programs that prioritize emotional well-being alongside academic and clinical guidance can foster meaningful connections and provide crucial support.
Self-Compassion Practices
Mindfulness, journaling, and other methods of checking in with yourself can provide daily opportunities to combat the perfectionistic tendencies that fuel shame. Resources like Brené Brown’s books and projects like The Shame Lab and The Shame Space also offer structured exercises to help physicians process shame in healthier ways.
Institutional Changes
Shame resilience training can be woven into medical curricula, starting from orientation. Debriefing sessions, open forums after adverse events, and non-punitive error-reporting systems create environments where healthcare professionals can own up to their mistakes, learn, and move forward—rather than become consumed by shame.
Addressing the Ego Paradox
Surgeons and other high-stakes professionals often need strong self-confidence to operate effectively, but that very confidence can become an obstacle when it prevents vulnerability. Recognizing that ego is a double-edged sword can help us remain decisive in clinical settings while still acknowledging our fallibility and the need for emotional support.
The Bottom Line: Transforming Shame into Resilience & Compassion
Shame is a universal emotional experience, particularly in the high-pressure world of medicine. However, it doesn’t have to be a permanent scar on our identity or a barrier to providing compassionate care. As Dr. Bynum reminds us,
“This is not an emotion to run from… if you can start by not denying it, and then finding a way to recognize it and accept it in yourself, that’s one of the most crucial first steps towards more healthy engagement with this emotion.”
By learning to recognize and discuss shame openly, we can transform it from a paralyzing force into an opportunity for both personal and professional growth. This shift not only preserves mental health but also enhances our capacity to serve patients with empathy. Embracing shame competence calls us to cultivate a healthier, more compassionate medical culture—one where mistakes are seen as learning opportunities, and vulnerability is met with understanding rather than judgment. Through vulnerability and open dialogue, we can become the best versions of ourselves, creating a ripple effect that benefits both providers and patients.
Related Topics
For more insights on how to support well-being and growth in the medical field, check out these articles:
- The 75% Rule: Sustainable Practices to Combat Burnout in Healthcare
- Leadership in Medicine: A Pillar of Effective Healthcare
- Managing Conflict & Fostering Strong Professional Relationships in Medicine
- Mentorship in Medicine: Forging Lifelong Connections & Enhancing Career Success
This blog post was inspired by insights from Dr. Frances Mei Hardin and Dr. Will Bynum on the “Promising Young Surgeon” podcast episode “Emotional Vulnerability, Shame Competence, & Medical Training with Dr. Will Bynum.”
