### Wrestling with Shame in Medicine: The Burden of Imperfection in the Healing Profession

Medicine is frequently regarded as among the most esteemed and fulfilling careers. It is a globally admired pathway, emblematic of altruism, intellectual strength, and the ability to save lives. Yet beneath the white coats exists a frequently unvoiced emotional load that professionals bear—a murky influence molded by capitalism, institutional demands, personal sacrifices, and societal expectations of flawlessness. For numerous individuals in medicine, this burden takes the form of **shame**—an all-encompassing and damaging emotion that endures when results fall short of the unattainable standard of perfect practice.

#### A Field Rich in Sorrow and Grief

In her heartfelt reflection, psychiatrist Dr. Courtney Markham-Abedi presents a sincere examination of her own inner conflicts—the aftermath of death, mourning, career sacrifices, and the relentless pressures of medical practice. For doctors like her, these challenges feel particularly lonely. When patients die or negative outcomes arise, many physicians grapple not just with sorrow but also with an intense sense of self-reproach. Even in the absence of error, the nagging question remains: “Could I have done more? Should I have performed better?”

The intensity of this situation amplifies in medicine, where life-and-death circumstances are frequent. Doctors, as caregivers, sometimes equate negative outcomes with personal shortcomings. Shame becomes a burdensome visitor, its stifling presence exacerbated by a culture that has long associated strength with stoicism. For Dr. Markham-Abedi, this shame surfaces during moments such as learning of a patient’s death or contemplating career milestones overshadowed by painful personal experiences—returning to work shortly after childbirth or dealing with a devastating pregnancy loss, for instance. A profound sadness permeates her narrative, intertwining personal sorrow with professional guilt, even when logical thought assures her she is not at fault.

#### The Volatile Nature of Shame

Shame is a common emotion, but in the realm of medicine, it often feels particularly potent. The Oxford English Dictionary defines shame as “the painful feeling of humiliation or distress caused by the consciousness of wrong or foolish behavior.” At its essence is the conviction that one’s shortcomings are exposed and that a failure, whether real or imagined, signifies personal incompetence or even a moral shortcoming.

In fields such as medicine, shame possesses a nearly insidious quality. It can emerge in response to outcomes beyond one’s influence—such as death due to an incurable disease or a mental health crisis culminating in a patient’s suicide. While physicians frequently compartmentalize emotions to operate effectively in their roles, the burden of unacknowledged shame steadily accumulates, breaking through these barriers in expressions ranging from burnout to addiction to self-destructive thoughts.

Shame, as Dr. Markham-Abedi notes, “fills the metaphoric room” with its overwhelming presence, impacting not just the individual harboring it but spreading distress outward. It seeps into minds, accelerates heart rates, and amplifies the loneliness felt by medical practitioners. Sadly, isolation is prevalent in this field, as confronting shame often entails admitting errors, something that many doctors are conditioned to evade at all costs. In a medical environment that values perfection—where even the hint of imperfection feels condemnatory—shame becomes profoundly damaging to the spirit.

#### Sacrifices, Perfectionism, and the Unattainable Ideal

The nature of medicine necessitates personal sacrifices that are rarely demanded by other vocations. For Dr. Markham-Abedi, these sacrifices encompass completing on-call shifts following a cancer diagnosis, returning to work just weeks after childbirth, or dealing with grief while managing clinical duties. Many physicians derive strength and purpose from their capacity to handle these intense moments, but that very drive for resilience fuels the culture of perfectionism. Medicine implicitly requires doctors not only to dedicate their lives to others but also to uphold unattainably high standards without faltering. When they inevitably do not meet these expectations—because humans are intrinsically imperfect—they are confronted with shame.

A striking paradox of medical practice emerges: doctors face illness, suffering, and death daily, yet they internalize their inability to prevent these outcomes perfectly as personal failings. Even when decisions and interventions strictly adhere to established guidelines, shame persists due to one’s proximity to suffering. The inability to save everyone induces enduring emotional scars. This shame festers unless physicians discover a meaningful outlet to work through it.

#### The Consequences of Shame in Medicine

The serious ramifications of shame in medicine are profound and far-reaching. It heightens stress, diminishes mental health, and contributes to issues like addiction and physician burnout. Most alarmingly, physicians experience **higher rates of suicide** than the general populace. While this issue is complex with various contributing factors—including demanding work hours, systemic pressures, and stigma surrounding mental health—many argue that a “fragile relationship with shame” plays a role in these tragic outcomes.

Dr. Markham-Abedi illuminates the darker side of this reality.