When Doctors Make You Feel Guilty

Feeling ashamed of the bad behavior, instead of feeling ashamed of yourself, leads to better outcomes.
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Okay, I know I’m a health writer, but I really don’t like going to the doctor. Part of it is an unshakeable, irrational certainty that they will find something horribly wrong with me that I’d rather not know about, and part of it is a rational certainty that they will find something mildly wrong with me that is my fault and chastise me for it—drinking too much, not exercising enough, whatever.

One should be able to talk to one’s doctor about these things—the aspects of one’s lifestyle that maybe aren’t so great. In 2010, the Surgeon General recommended that physicians talk openly about weight issues with their patients, a reasonable suggestion. But in 2009, a study by researchers at the University of California, San Diego found that half of the patients surveyed had experienced shame as a result of something a doctor said to them.

In a new study, forthcoming in Basic and Applied Social Psychology, the researchers expand on that work to figure out why people react either positively or negatively to doctor-induced guilt. The initial study saw that 45 percent of people who felt shame made questionable health choices as a result—lying to their doctors, avoiding them, or even quitting treatment with them. But 33 percent saw the shame as a motivator, and tried to improve their health as a result.

The new study looked at both a group of college students and a general population of adults. Participants self-reported how many times they’d felt shame while interacting with a doctor, described their most recent such encounter, and filled out the State Shame and Guilt Scale. They also reported whether they thought the doctor was intentionally shaming them; whether the condition in question got better, worse, or was unaffected by the incident; and how they reacted—by avoiding, lying, or trying to improve.

In the younger group, 23 percent of participants had had an encounter that made them feel ashamed, among the older group, 43 percent had.  In the older, group, guilt was a more common emotion than shame—52 percent had felt guilt after a doctor’s visit. However, the researchers found that patients’ reactions to shame and guilt were very similar. People reported being shamed for a variety of things, most commonly weight, sexual activity, and teeth.

The key difference that the study found between those who were inspired to change based on the shameful experience and those who avoided, lied, or otherwise reacted negatively was a person’s ability to distinguish between himself and his behavior. Those who saw that the doctor was condemning their behavior were more likely to make efforts to improve, and those who felt that they themselves were being attacked were more avoidant in their reactions.

"Patients who think 'okay, I engage in some unhealthy behaviors but this doesn't mean I'm a bad person' are more likely to be motivated to change those behaviors," says lead researcher Christine R. Harris. 

People who felt more capable of change were also more likely to have positive reactions to the guilt, but the opposite was not true—feeling less capable of change didn’t necessarily mean someone would react negatively.

"We think the positive consequences are partially due to patients feeling that  bad behaviors can be changed and therefore they can improve their health problems," Harris says. "They also appreciate and admire the physician more in these situations... When one thinks the whole self is bad, one doesn’t feel like there are a lot of options for improvement."

Harris recommends that doctors focus on improving patients' specific behaviors, which will hopefully help them disentangle what they do from who they are, and allow them to take whatever shame they may feel while sitting in that paper gown and turn it into positive change.

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Julie Beck is an associate editor at The Atlantic, where she covers health.

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