How Shame Impacts the Medical Profession

Duke physician’s research highlights overlooked emotion and its impact

-By Charles Givens

April 5, 2023

Tying one’s identity to a profession is common in the modern-day work culture. We often revere “the grind” and emphasize the “work hard, play hard.” Rarely do professionals take a step back to examine their work culture and what it might do to a person physically as well as psychologically. One Duke physician is exploring that very subject.

Will Bynum, MD is currently the Program Director at Duke’s Family Medicine Residency. In 2017, Dr. Bynum joined Duke University School of Medicine and is now an Associate Professor of Family Medicine. Prior to his arrival, he served for several years in the U.S. Air Force, where he fulfilled various roles, including faculty duties in the National Capital Consortium Family Medicine Residency Program and Senior Medical Director of a special operations command in East Africa.

Dr. Bynum’s primary academic focus involves investigating the impact of self-conscious emotions, such as shame, guilt and pride, on medical learning. He has conducted this research through a recently completed PhD program in health professions education at Maastricht University in the Netherlands and with financial support from the Office of Global Affairs.

Dr. Bynum’s research stemmed from a moment during his residency when he made a medical error on a patient. In the recovery of that error, he discovered that he was experiencing shame and began exploring what the emotion can do to a person in the medical field.

“Shame, by definition, is an emotion that happens when we evaluate ourselves,” said Bynum. “So, when we feel shame, we are actively contemplating who we are as people and how we are achieving or failing to reach standards we’ve set for ourselves or that others have set for us. In the case of shame, we attribute failing to reach those standards to something about us as a whole person.”

Dr. Bynum believes that to have shame work constructively, there must be a shift of the blame from something global about a person (e.g., their intellect or competence) and onto something that can be fixed (e.g., a knowledge deficit). He identified shame as one of the most powerful motivators in human behavior. But for shame to transition to a more of a constructive emotion, the professional workplace must facilitate some degree of self-compassion and self-forgiveness.

WE NEED TO CREATE ENVIRONMENTS WHERE [SHAME] CAN BE OPENLY EXPRESSED AND ENGAGED WITH

Since COVID-19, the state of healthcare in the United States has been under a microscope, with the public becoming more aware of burnout, low morale and depression in medical professionals. While all these symptoms are valid, Dr. Bynum also sees a need for shame to be seen and addressed as another form of distress. “We need to create environments where it can be openly expressed and engaged with,” said Bynum. “Those environments don’t just happen. They need to be cultivated and maintained as places where people can be their authentic selves.”

There is a long road ahead for healthcare professionals to get both the physical and mental help they need. Dr. Bynum feels that what sets physicians apart from other professions is the humanistic element; that a person goes into this field to serve others. To combat the current malaise in physicians specifically, he suggests exploring the humanist nature of the profession, with shame as a potential guide.

“Shame is a normal, albeit painful, emotion. Not allowing or supporting physicians in engaging with their shame significantly exacerbates that de-humanizing trend,” said Bynum. “Therefore, if we make true safe spaces to engage shame, then we do the opposite. We humanize them. That’s what healthcare needs right now.”