5 - Shame in Medicine: Indoctrination
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What early experiences first introduced the culture of shame in medical training?
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Thanks for listening to the Nocturnist Shame in Medicine, The Lost Forest. If this is your first time tuning in, I recommend that you rewind and start at episode one. This is a series that builds on itself over time, so we think that starting at the beginning will offer the richest listening experience for you. Enjoy the show. When I was a medical student on my surgery rotation. Every time I went into the OR, I felt like I was being watched. There's this very involved scrubbing process where you have to wash your hands down to your elbows and then put on a gown in a very specific way and then twirl and have it be tied and snapped in a certain way. And as I went through these motions. It felt like The scrub nurses were watching me like hawks and just waiting for me to make a mistake.
And when I did make a mistake, even a small one like just stepping an inch too close to a tray of instruments or bumping my butt against something. They would tell me to go outside and try again. Go outside, try again. And then once you're in the operating room, you're surrounded by these men. They're shooting the shit, talking to each other over this anesthetized patient. And sometimes it's a good natured sort of poking fun at each other, but sometimes even the attending would say demeaning things to his learners. People would laugh, but I'm not sure they really liked it. And my instinct was just to be as small as I could. And so that's my headspace when the attending turns to me and says, Medical student.
sew this wound and he hands me a needle. And at some point during the sewing I felt a prick on my finger. And I looked at my glove and I couldn't tell if I had actually poked myself or not. I did not see a hole in the glove. I did not see any of my own blood on my hand, but I had definitely felt something. But I remembered that what you're supposed to do if you stick yourself, or even if you think you stick yourself. is to stop what you're doing, walk over to the sink, wash your hands with soap and water. And then call the needle stick hotline and await further instructions. But I couldn't wash my hands. I was scrubbed into the OR. I was knuckled deep in this patient's body, surrounded by surgeons, blocked on all sides.
And it didn't even occur to me to speak up and say, Hey, I think I stuck myself. I'm gonna step out. Like that was just not a possibility. There was no way I was going to interrupt this very important surgery with these very important surgeons. And so I just kept sewing. And then when the case finally ended, I took my glove off and I washed my hands and I looked at my skin and I couldn't see an obvious wound. But again, it was a pretty small needle. So I decided to call the needlestick haul line and the person on the other end of the phone, they said, Give me the information of the patient and I did that. And then they said Now we're gonna send a bunch of tests on the patient's blood to see what they have so that we know what your risk is.
And the first words out of my mouth were no no no, please don't do that. And they said, Well, why not? And I said, I don't want you to order any extra tests on this patient because I don't want these surgeons to know I was imagining it in my mind. I was imagining Dr. X opening the chart, seeing that these extra tests were ordered, and then Turning to the person next to him and saying, Who ordered these tests on my patients? Why were these tests ordered? And then all of the residents looking at each other and saying, We didn't order it. We don't know why. And then them embarking on this like quest to figure out who ordered them and why. And then finally finding out that it was the stupid med student who stuck herself during a surgery and now had to order these extra tests.
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Chapters
8 chapters
1
What early experiences first introduced the culture of shame in medical training?
0:00–5:28
2
How did the medical student’s needlestick incident illustrate the impact of shame on decision‑making?
5:28–10:54
3
What patterns of shame emerged from the residents’ and interns’ personal stories?
10:54–15:06
4
How does chronic shame affect learners’ confidence and willingness to take risks?
15:06–18:55
5
Can shame ever be an effective teaching tool for memory retention?
18:55–24:07
6
What are the hidden costs of using shame as a pedagogical strategy?
24:07–29:37
7
How might educators redesign training to reduce harmful shame while preserving learning?
29:37–35:15
8
What practical steps can learners take to reclaim agency when shamed?
35:15–39:17