Shame and humiliation in the medical encounter

• Patients are at high risk for experiencing shame and humiliation in any medical encounter. This is because they commonly perceive diseases as defects, inadequacies, or shortcomings; while the visit to the hospital and the doctor's office requires physical and psychological exposure. Patients respond to the suffering of shame and humiliation by avoiding the physician, withholding information, complaining, and suing. Physicians may also experience shame and humiliation in medical encounters resulting in their counterhumiliation of patients and dissatisfaction with medical practice. A heightened awareness of these issues can help physicians diminish the shame experience in their patients and in themselves. Twelve clinical strategies for the management of shame and humiliation in patients are discussed. (Arch Intern Med1987;147:1653-1658)