The Silent Weight of Shame in Medicine

Some patient encounters stay with you long after they end. They creep into your thoughts when you least expect it, surfacing years later with a familiar pang of regret.

I had one of those moments as a resident. I was a newly minted senior, still adjusting to the relentless pace of seeing 10 to 12 patients in a half-day clinic. I was running behind, having just finished a visit with a patient struggling with severe anxiety and depression—a conversation that most definitely did not fit into a 15-minute follow-up slot.

Then came my last patient of the day, a middle-aged man scheduled for an "establish care" visit. Only, it wasn’t just that. He had a list of literally 12 things that he wanted to address. I did my best, but after 30 minutes in what was supposed to be a 15-minute visit, I finally said, "That’s all we have time for today."

He looked at me, confused. "What do you mean? I still have six more things." Frustration crept into his voice. In that moment, I felt torn between my duty to provide the best care possible and the limits of the system I was working within. I wanted to give him the attention he deserved, but I also knew that I was way, way behind schedule. I tried to problem-solve. "We were scheduled for 15 minutes. Can we bring you back to talk about the rest?"

His expression darkened. "No. That’ll take another two to three months. I can’t wait that long. I’ve waited long enough."

He was a care navigator, someone who spent his days guiding patients through the healthcare system, ensuring their concerns were heard and addressed. And now, when he finally took some time and prioritized himself, he felt like no one was there to help him. "Doctors get paid for not doing anything," he said bitterly. Shame hit me like a wave.

I wanted to tell him how hard I was trying. That I cared. That I was drowning under an impossible workload. But in that moment, none of it mattered to him.

I apologized profusely and sincerely. And so, I stayed another 30 minutes, running even further behind, thinking that trading time would appease my guilt, which might make both him and myself feel better.

I told myself that day: I will never let another patient feel unheard again. The guilt and shame of that encounter lingered long after, shaping how I approached medicine in the years that followed.

The Silent Burden of Shame

It took me years to confront that moment, to think it through and analyze it. In fact, this is the first time I’m speaking about it out loud, and publicly. Because shame is like that. It silences us. It isolates us. And in medicine, it thrives.

Shame is woven into the fabric of our profession. It comes from societal expectations that doctors should be always available, selfless, and tireless. It comes from our employers, who demand higher productivity and efficiency, and sacrificing quality care and our humanity in the process. It comes from our peers, some who rarely admit to struggling, reinforcing the illusion that we should always have it together. And, most of all, it comes from within, from the brutal expectations we place on ourselves.

A study published in JAMA found that nearly 82% of surgical residents experienced at least one adverse patient event during their residency and reported feelings of embarrassment, shame, and rumination afterwards. 35% of these residents even considered quitting. Similarly, their faculty described feelings of guilt and shame, loss of confidence, and distraction after an adverse event.

These levels of shame are in direct conflict with a physician’s identity. Historically, physicians have been expected to embody perfectionism, infallibility, and emotional detachment. Consequently, when a mistake is made, physicians often experience self-doubt and shame, perceiving their errors as personal inadequacies, and often times, a reflection on their self worth and value, rather than as part of the learning and growth process.

Physicians who experience high levels of shame-related distress are more likely to suffer from burnout, depression, and even suicidal ideation. When the culture of medicine demands perfection, there is no room for error.  This expectation is unattainable simply because the truth is that physicians are human.  Inevitably, when there is human error – which there will be sooner or later – physicians are unequipped to deal with the emotions associated with acknowledging imperfection, coping with vulnerability, and offering themselves grace.  It is no wonder that physicians face some of the highest rates of mental health struggles despite their income and perceived success. The weight of shame, left unspoken, becomes unbearable.

My error that day? I made someone feel like he didn’t matter. When, in fact, he was the one who mattered most. That realization—that shame—was heavy to carry.

Breaking the Silence

Many of us are incredibly high achievers with high emotional intelligence.  Yet, we still don’t openly talk about it.

Why do we do this? Brené Brown states that shame stems from an inherent belief of being flawed and unworthy.  A fear that if people really know what we were going through, they would judge us, or think less of us. In medicine, this fear is amplified.  It’s not just about fitting it socially, it’s about medical competence, credibility and in many ways, questioning the very identity of who we are.  This makes shame in medicine so powerful that it leads physicians to hide mistakes, to internalize guilt, to suffer in silence. Instead of addressing the systemic flaws that drive burnout and medical errors, the blame falls squarely on the individual physician.

But we don’t have to keep carrying it alone.

We can begin to break the silence by telling the truth, first to ourselves, and then to each other. We can normalize vulnerability by modeling it, not as weakness, but as courage. We can start peer groups, mentorship circles, reflective writing sessions, and other safe spaces where honesty is not just welcomed, but expected. We can speak up in meetings, not just about patient safety, but about physician safety. We can advocate for protected time in medical education for emotional processing, not just clinical reasoning. We can push for institutional culture shifts that value humanity over productivity, compassion over metrics. And when someone shares something hard, we can meet it not with discomfort or advice, but with presence, listening, and empathy. We can allow ourselves to admit it too, that we are tired, that we are hurting, that we need support.

Because every time one of us speaks up, it makes it safer for someone else to do the same. Little by little, conversation by conversation, that’s how we begin to change the culture. And yes, culture change is hard. It’s slow, and at times, painfully incremental. But just because it’s slow doesn’t mean it’s not worth the effort and that it’s not happening. The more we speak, the more we shift the weight away from shame and towards connection, community, and healing.

Naming Shame, Reclaiming Humanity

I did see the patient again for a follow-up visit. I addressed all of his concerns the second time around. He told me he’d give me five stars based on that single visit. But I heard the undertone. I got the lesson. 

It’s funny how one patient—one moment—can change everything. The truth is, I was a resident, and I was learning.

But the real lesson that day wasn’t about time management or agenda-setting. It was about what our patients aren’t telling us. It was about the ways our system fails them, and fails us.

Six years later, I still feel hurried in clinic. But I’ve learned how to set clearer boundaries. I’ve learned the tricks of the trade to make patients feel seen and heard. I’ve learned how to set an agenda without making someone feel dismissed. And with experience, the medicine flows more naturally now.

But the shame? It doesn’t fully disappear. It lingers in the quiet moments, when we can’t do enough, when we feel like we’re failing despite trying our best. And that’s why we need to talk about it.

Because shame loses its power when we name it. It brings us back to the values we hold most dear—autonomy, honesty, compassion, vulnerability. Everything that makes us human.  Everything that connects us to our patients. Everything that makes us good doctors.

It’s time to let go of the unrealistic expectations. To practice self-compassion. To remember that doctors are human too. 

And to remember that:

Sometimes there are no easy solutions.

Sometimes there’s nothing we can actually do to fix the problem.

Sometimes we’re just meant to sit there, to listen, to bear witness.

Sometimes our presence is the medicine.

Sometimes our patients don’t need us to actually do anything. They just need us to care.

Maybe the culture of medicine won’t change overnight. But it can begin with honest conversations, with small acts of vulnerability, with the courage to tell the truth about what it really feels like to be a doctor today. Not the polished version. The real one. The one where we’re allowed to be both compassionate and exhausted. Both competent and unsure. Both human and healing. And maybe, just maybe, that’s how we start to heal not just ourselves, but the profession we still care so deeply about.

Resources

Miles S. Addressing shame: what role does shame play in the formation of a modern medical professional identity? BJPsych Bulletin. 2020;44(1):1-5. doi:10.1192/bjb.2019.49

Gerada C. Doctors, suicide and mental illness. BJPsych Bull. 2018 Aug;42(4):165-168. doi: 10.1192/bjb.2018.11. Epub 2018 May 1. PMID: 29712575; PMCID: PMC6436060.

Ginzberg SP, Gasior JA, Passman JE, et al. Surgeon and Surgical Trainee Experiences After Adverse Patient Events. JAMA Netw Open. 2024;7(6):e2414329. doi:10.1001/jamanetworkopen.2024.14329

Erikson, Erik H. Identity and the life cycle. WW Norton & company, 1994.

Brown, B. Daring Greatly: How the Courage to be Vulnerable Transforms the Way We Live, Love, Parent, and Lead. Gotham Books, 2012.

A version of this piece was originally published on Psychology Today, where Dr. Cynthia Chen-Joea is a regular contributor. https://www.psychologytoday.com/us/blog/the-other-side-of-the-white-coat/202507/the-silent-weight-of-shame-in-medicine