Have you ever left a doctor's office
feeling ashamed or guilty? Chances are one in two that you answered
"yes", according to research from the University of California, San
Diego. And what happened next? Perhaps you were motivated to make changes in an
unhealthy behaviour. Or did you just lie to that doctor on subsequent visits?
Avoid him or her? Maybe even terminate treatment entirely?
Shame and guilt as a direct result of
interacting with a doctor are quite common, says Christine Harris, professor of
psychology in the University of California San Diego Division of Social Sciences, as are both
positive and negative reactions. But surprisingly little research has been done
on the subject.
Now, in a pair of new studies, Harris and
colleagues examine the consequences of these physician-inspired feelings. They
also explore why some patients react to the shame- or guilt-provoking
experience in a way that promotes health while others turn to lying or
need to understand their patients
Gaining insight into patient reactions is
important, the co-authors write, because "more than one third of all
deaths in the United States are still essentially preventable and largely due
to unhealthy patient behaviour."
Published in the journal of Basic and
Applied Social Psychology, the current paper follows up on Harris' 2009 work
showing that more than 50% of respondents had experienced shame based on
something a physician said. The earlier work also documented the diversity of
In the current paper, Harris and her
co-authors – recent UC San Diego psychology Ph.D. graduate Ryan Darby and
current doctoral student Nicole Henniger – ran two related studies: One
surveyed and analysed the responses of 491 UC San Diego undergraduates about
shame when interacting with a doctor. The second looked at both guilt and shame
and included 417 participants from a wide-range of socioeconomic backgrounds,
aged 18 to 75.
Weight and sex
In the younger cohort, nearly a quarter of
participants had experienced a shaming encounter with a physician. In the
mixed-age group, roughly half had, Harris said.
In both studied groups, weight and sex were
the most frequently cited shaming topics. Teeth came up frequently with the
younger subjects as well. (Possible topics also included smoking, alcohol or
substance use, not taking prescribed medications or following doctor's orders,
and mental health, among others.)
Family practice doctors, gynaecologists and
dentists were the specialties most often cited as shaming. This is probably
because, Harris said, people generally see these types of physicians more than
As in the 2009 work, the emotional and behavioural
reactions to the shaming experience varied widely: from making a profound
lifestyle change to improve health to, on the opposite extreme, just avoiding
all doctors altogether.
What matters most and seems to make the
greatest difference, Harris said, is whether the patient "makes a global
attribution, condemning the entire self" or just condemns the behaviour at
hand. Focusing on the behaviour leads more often to good outcomes.
"People who report a more positive
reaction focus in on a bad act not a bad self," Harris said.
"Capacity to change mediates the response. In the simplest terms: Those
who say 'I'm a smoker' or 'I'm a fat person' may feel resigned while those who
say 'I smoke' or 'I eat too much' also seem to think 'I can stop doing
Also significant, the researchers find, is
the patient's perception of the doctor's intent.
"If you perceive your doctor is
intentionally trying to make you feel shame or guilt, then the reaction is
exclusively negative," Harris said. "We didn't see any positive
reactions at all."
There were differences by gender, too: women reported experiencing shame and guilt during doctors' visits more often
than men did. They also reported more negative reactions. But, interestingly,
this doesn't seem to be because women are making more global attributions.
The reason for the gender difference
remains an open research question, Harris said. It could be that doctors treat
men and women differently. Or it could be that women hear the signal more
strongly or have differing perceptions of the interaction.
In the meanwhile, Harris said, doctors will
continue to have the unenviable task of discussing delicate subjects with their
patients and with making recommendations about unhealthy behaviours, and what is
clear is this: "Tough love and shaming don't always work. In fact, they
can be counter-productive."
"To improve outcomes," Harris
said, "doctors need to try to keep the conversation focused on the behaviour
(not the person) and avoid, as much as possible, being perceived as
intentionally inflicting shame or guilt."
As for patients, the best advice she can
give is: "Think not of what you are but what you can do."
like eye contact from doctors
often biased against fat doctors
Doctors feel less sympathetic toward obese patients