I’ve been reading a lot of Brene Brown over the past year, and it prompted me to think more about the role of shame and guilt in healthcare.

As a doctor and as a woman, I know well how shame and guilt can color our experience of illness, motherhood, sexuality, food and just existing in our physical bodies.

The more I reflected on this, the more I realized that shame and guilt are somehow present in the vast majority of my patient encounters. I decided to make a list of the most guilt/shame triggers I see in practice:

• numbers (ex: weight, blood pressure)
• behaviors (ex: smoking, drinking, eating habits)
• diagnoses (ex: psych conditions, sexually transmitted infections)
• medication (ex: taking them too much, not taking them enough)
• having too many questions/concerns
• feeling scared/anxious/depressed
• grooming (ex: leg hair, ear wax, chipped polish)
• investing time/money/energy into their own health (ex: counseling, PT, fitness)

I believe the first step in addressing shame and guilt in healthcare settings is simply acknowledging the elephants in the room.

For physicians, many of these triggers don’t even phase us (I really don’t notice leg hair, and ear wax is really not an indicator of poor hygiene!). But doctors are also human, and we inevitably have our own personal implicit biases. It is our job to be acutely aware of these biases, to not allow them to affect our clinical care and to always lead with empathy.