Shame competence: addressing the effects of shame in health care (19 October 2024)

Summary

Although shame is an inevitable human experience, it is often experienced as a negative emotion that drives disconnection, psychological distress, impaired empathy and disengagement. The work of healthcare is infused with risk for shame and this Lancet article looks at the impact it can have on both staff and patients.

Healthcare encounters are intimate interactions that can be overshadowed by perceived judgement and negative self-evaluation. Patients may feel ashamed, embarrassed or negatively judged about their bodies, their behaviours or their circumstances. Patient shame can be related to stigmatised experiences such as mental illness, obesity, sexually transmitted infections or substance use. The often well-intentioned “lectures” from doctors that such conditions evoke can increase shame feelings in patients who may already feel insecure or ashamed about their bodies or health conditions.

Healthcare professionals can also be subject to the impact of shame as for many, identity and self-esteem are linked to achievement, reputation and belonging in their profession, all of which are, in turn, linked to patient care. They may feel inadequate or negatively judged about their skills, failures and errors, their own mental or physical illness, or their inability to “fix” a patient.

The authors argue that engaging healthily with shame presents an opportunity for meaningful transformation in healthcare. Competently acknowledging, recognising and responding to shame will support humane connection, enhance psychological safety, infuse trust and instil the emotionally sensitive healthcare environments that we all need to do the vulnerable work of healing.