Researchers to investigate impact of shame on doctors, medical students and patients as part of major new study

Existing research indicates that shame can play a significant role in the clinical encounter. It can lead to patients avoiding treatment and concealing illness. It may also influence how doctors interact with their patients, and their colleagues, and appears related to burn out, suicide and mental health problems among those working in the medical profession. Shame also seems to be frequently experienced by medical students during their training.

The new project, funded by Wellcome, proposes to identify and evaluate real-time experiences of shame within the NHS. Researchers hope this will lead to more understanding of how shame can get in the way of positive healthcare experiences, for both patients and doctors.

Experts will analyse the impact of shame on patient experiences, as well as how, when, and why, medical professionals, and students, experience shame and the influence that these experiences have on their motivation, wellbeing, and developing sense of professional identity.

Experts will also analyse literature, television, film and social media to assess how shame in healthcare is represented in culture.

Doctors – GPs around the UK and those working in hospitals in the Midlands - will keep a log of when situations result in shame experiences. They will also be interviewed about their experiences. Researchers will also interview doctors who have been disciplined by the General Medical Council to understand the role of shame in medical regulation.

Patients will be asked to provide a written or audio record of when they felt shame while receiving healthcare.

Medical students will complete a critical incident log of an experience of shame at least once a month for one academic year and some students will be interviewed to gain more detail about their experiences.

The project, which lasts for five years, will be run by Dr Luna Dolezal from the University of Exeter, Dr Matthew Gibson from the University of Birmingham, and Dr Barry Lyons a consultant anaesthetist and bioethicist at Children's Health Ireland hospital in Dublin. 

Dr Dolezal said: “Shame is such a taboo emotional experience that it is very hard to investigate, but by examining different aspects of the medical profession, as well as popular culture and patient experiences, we can analyse its impact. Shame can be harmful, but it isn’t always a negative force.”

Dr Gibson said: “We will be developing new ways to research shame so we can really understand the role it plays in medicine. We know from experience that we don’t talk about shame very much, but we also know from research it can have a very big impact on what people do and how they do it. What we don’t know is what kind of an impact it has in medicine and healthcare.”

Dr Lyons said: “It is suggested that shame arises in doctors and medical students as a combination of the educational and regulatory environments, and an inherent tendency to perfectionism. We will be reaching out to communities to try to understand professionals’ experiences, and how their emotions impact upon their relationships with other clinicians, students, and patients.”

A series of workshops will be organized throughout the project with medical educators, students, relevant advisory board members and collaborators to develop recommendations for medical schools.

The study will also result in a new book about shame for healthcare professionals, academics, and students working in medical schools.