Blame and Shame in Medicine

In responding to many discussions across physician communities about how shame and blame are navigated in medicine, responses to the recent NPR article (Huff, 2025) revealed some consistent misunderstandings. Themes include confusion between shame and guilt and the appropriateness of using shame and judgement versus nurturing growth as a teaching tool. The definition of shame depends on the discipline from which it is borrowed but a common denominator is the sense of wanting to disappear into the floor boards. It is a particular knowledge that one singularly deserves to be cast out. It is the primitive, overwhelming feeling, the experiencing of one’s core-being as reprehensible, that characterizes shame. And everyone recognizes the painful wash of shame. Guilt, by contrast acknowledges a wrongdoing for which amends are in order. Guilt reflects an inner conscience with a solution. While guilt can have positive social impact guiding response to behavior and choices, shame does not offer a solution because it feels like there is none, cornered at an abyss from which there is no return. Shame wants to hide, and in hiding, feelings of shame can grow.

Many physicians experience a deep sense of shame when things go awry in patient care, particularly when a patient is injured, but it is rare for this to be routinely discussed in the open. Instead the physician shows up to work carrying the unrelenting burden of feeling that everyone is watching and judging. It becomes more difficult to concentrate, and decision making is now more informed by danger to self-esteem. Additionally, shame and self-doubt are often well hidden which forecloses opportunity for essential connection, understanding, and acceptance.

Huff (2025) describes the impetus behind concerted efforts to alter managing shame in the medical training environment to improve overall well-being of student and staff, and ultimately, it is hoped, the practice environment in general. Bynum, the physician behind this movement describes an experience every single resident will share prior to matriculation. There is no escape from involvement in the care of a patient who has a poor outcome, is injured in a procedure, or is the first victim of a medical error, with the clinician being the second victim. Extensive research has delineated some key characteristics of navigating this most vulnerable time for a physician, distinguishing what is helpful and what is harmful. An overarching goal is to assist clinicians through this process and prevent exiting the career entirely or worse. This involves accepting hard truths, restoring realistic self-esteem, and integrating the experience and its complex feelings to mitigate the fear of recurrence that impedes clinical decision making.

Traditionally doctors have held themselves to extraordinarily high standards in efforts to minimize the above. Unfortunately, in so doing the idea of perfect performance has stigmatized perceived failure, with negative impacts on resources to help navigate those events effectively. Among other things this contributes to high rates of depression, anxiety, substance use, PTSD, and suicide among physicians. But it isn’t just upholding impossibly high standards entrenched in medical culture that is so counterproductive. Compartmentalizing the feelings that arise when helping patients through difficult processes and the misperception that outcomes can be controlled with strict hypervigilance also synergize negatively. There is misplaced pride in unrealistic stamina and a failure to understand the consequences of long suppressed feelings, the ongoing energy expenditure of self-denial.

In addition to spaces which effectively mediate judgment and prohibit legal scrutiny so that physicians can effectively open up about experiences and their impact for productive conversation, more encouragement to seek help before crisis level could potentially mitigate unnecessary suffering. This would also improve services offered from a healthier perspective. There is no escaping the complex feelings associated with being responsible for the care of the ill and injured. Furthermore, they serve a better purpose incorporated into the deep sense of meaning in service delivered authentically over the course of a career helping others.

Article and resources posted below.

Huff, C. (2025). These doctors want to break the cycle of shame and blame in medicine.

www.npr.org

These doctors want to break the cycle of shame and blame in medicine

Shaming is common in medical school and unfortunately, sometimes in the doctor's office. Some doctors are trying to teach medical students awareness of the problem so they don't perpetuate the cycle.

shamelab.org

Will Bynum, MD PhD

www.ncbi.nlm.nih.gov

Second Victim Syndrome

Health care workers often expect perfection from themselves, and societal opinions reinforce this expectation. However, perfection will always be an elusive goal, even for this group of hard-working, self-sacrificing, and altruistic humans. For decades, the system that trains and accredits medical providers, especially physicians, denied providers their own human imperfections and concomitant vulnerabilities. Mistakes in medicine were blamed on “bad” and/or imperfect physicians. Finally, in the 21 century, the Institute of Medicine admitted an undeniable truth in the oft quote publication, To Err is Human: Building a Safer Health System, when they asserted that “the problem is not bad people in health care--it is that good people are working in bad systems that need to be made safer.”[1]