Shame

We teach a required course for medical students that addresses aspects of medical practice that are hard to assess and make concrete, including professionalism, communication, ethics, humanities, and culture. Because this was the first iteration of a course created around issues that had been proven difficult to address rigorously in our curriculum, we designed the course around broad concepts that could provoke discussion on many fronts. In a session for approximately 80 second-year medical students, we explored the concept of shame and its possible manifestations in, and effects on, clinical medicine. For this first version of the course, we had the luxury and challenge of unusually long, multi-hour sessions, so we planned to address many variations of shame as it might manifest in either the patient or the provider role. Preparation for this session included readings from both professional and popular publications intended to offer several definitions of shame for consideration. Given the potential for evoking highly emotional content we decided to begin our large-group session with a fairly benign depiction of shame. We drew on the ubiquitous internet meme of ‘dog shaming’, in which social media users post photographs of their dogs with a sign around their necks describing their bad behaviour, often with evidence (e.g., destroyed furniture) appearing in the background. The