Why we need to talk about shame in medicine

Shame is one of the most powerful forces in health care, but it’s rarely named when discussing physician well-being. Although we’re comfortable talking about things like burnout, stress, anxiety and depression, we rarely confront how our mistakes, failures or other struggles impact our self-conscious emotions, or the feelings we hold about ourselves.

When ignored, these feelings quietly shape how we do our work, how we engage with setbacks, and how we relate to people around us. Shame is a specific self-conscious emotion that occurs when we fall short of a standard and feel negatively judged by others, and/or as if we’re flawed, deficient, or unworthy in a global sense. Maintaining awareness and learning to recognize when shame may be present are foundational components of “shame competence”, a framework that I co-developed with Dr. Luna Dolezal. Shame competence creates practical avenues for supporting well-being, building trust and creating stronger connections through proactive, constructive engagement with shame

I spoke about shame competence at the AAFP’s 2026 Whole Health Summit, where we explored practical ways to respond to feelings like these more constructively. Taking this direct approach can help us better support ourselves, our patients and the people with whom we work.

We view shame as a “present absence” in health care. It’s deeply influential but often hides out of view. We often potently feel the emotion internally, but we rarely name it, discuss it or seek support when it occurs.

As much as we may try to ignore it, shame often lurks underneath experiences we do talk about: medical errors, litigation, learning struggle, lapses in empathy and burnout. Each of these experiences can deeply affect how we perceive ourselves and how we think others perceive us. Naming these fears and feelings—which are ubiquitous among people—can help us recognize their inherently human nature, reframing them not as personal failures but rather as opportunities for self-exploration, growth, and connection with others.

Medicine creates fertile opportunities for shame, in part because our identities are so closely tied to how we perform. We hold ourselves—and are held by others—to exceptionally high standards, compare ourselves to peers, and often evaluate our worth against outcomes we cannot fully control. In this environment, even relatively minor setbacks can become threats to our sense of self, shifting focus away from what we might learn and toward what these experiences seem to reveal about our worthiness, belonging or competence.

Medical training and practice can also reinforce a culture of emotional stoicism where uncertainty, vulnerability and feelings of inadequacy are often experienced but rarely discussed. We learn to push through these experiences without fully recognizing or acknowledging their emotional impact, especially at the level of our self-evaluations.

As I began to better understand and recognize shame, I began seeing its influence everywhere—in my own experiences and in those of the people around me. I came to appreciate that shame was not a sign of personal weakness or professional inadequacy, but a normal part of the human experience that had largely gone unrecognized throughout my medical training and practice.

Physicians are not the only ones who experience shame in healthcare. Patients may enter clinical encounters feeling vulnerable about their health, bodies, behaviors or circumstances, often accompanied by concerns about how they will be perceived or judged. These experiences can how openly patients communicate with their clinicians, their willingness to engage in recommended care and even whether they seek or return for care.

My colleague Luna Dolezal has described shame as an “affective determinant of health,” recognizing that how people feel about themselves can meaningfully shape their health, well-being and engagement with health care. This framing encourages us to consider not only “How does this person feel?” but also “How does this person feel about themselves?” Actively considering this perspective can help us recognize shame, understand its influence on our patients’ care and respond in ways that preserve dignity rather than undermine it.

Shame competence is built upon five pillars:

Exercising shame competence can meaningfully shape everything from one-on-one conversations to workplace-wide culture. For example, when delivering feedback, shame competence directs us to highlight specific areas for improvement rather than enduring aspects of the entire person—“We need to work on your tendency to arrive late,” instead of, “You need to stop being so unprofessional.”

Within patient care, it encourages us to acknowledge the societal pressures and stigma that shape patients’ experiences (“There’s a lot of pressure in society to look and behave a certain way.”) while offering person-centered support that respects their individual perspectives and experiences (“How do you feel in your own body?”).

At the organizational level, shame competence involves examining policies, hierarchies and workplace practices that leave people feeling diminished, excluded or afraid to speak up. Recognizing how these structures shape individuals’ self-evaluations creates opportunities to modify them in ways that reduce the risk of shame and foster environments where people feel safe, respected and empowered to act authentically and speak up without fear.

The goal of shame competence is not to eliminate or avoid shame. Shame is a normal, evolved human emotion that plays an important role in regulating social relationships, behavior and our sense of belonging. Yet when shame goes unrecognized or unaddressed, it can become destructive, shaping how we see ourselves, relate to others and respond to challenging experiences. Shame competence helps us recognize shame when it arises, understand its influence and respond in ways that mitigate its potentially harmful effects while preserving its capacity to motivate reflection, connection and growth.

This is often easier said than done. It requires empathy, accountability and a willingness to acknowledge when our words or actions have caused harm. In health care, we often underestimate the power of a simple, sincere apology. Saying “I’m sorry” can be an important first step toward repairing harm, rebuilding trust and strengthening relationships, while helping to mitigate the shame that can arise when people feel dismissed, diminished or wronged.

I spoke about shame at the AAFP’s 2026 Whole Health Summit because a whole-person approach to health must account for how people feel about themselves. Our self-conscious emotions—including shame—are fundamental to the human experience, shaping how we see ourselves, relate to others and engage with the world around us. This is true for patients and health care professionals alike.

By openly acknowledging and discussing shame, we can mitigate its potentially harmful effects while fostering environments where people feel safe, valued and connected. Ultimately, shame competence is about recognizing that how we feel about ourselves matters, and that how we engage with shame can profoundly shape our relationships, behaviors and organizations.

Will Bynum, MD, PhD, is a family physician and adjunct professor of family medicine at Duke University School of Medicine. He practices clinically at Crystal Coast Family Practice and is a co-founder of The Shame Lab​, an organization that seeks to establish shame competence as a standard of professional practice.