In a groundbreaking recommendation, researchers from the University of Exeter and Duke University have urged health care professionals to incorporate 'shame competence' as a standard practice internationally. This initiative aims to improve the way healthcare settings address the often-ignored issue of shame that affects both patients and health providers alike.

The researchers argue that recognizing and minimizing shame—whether it is experienced by patients or medical staff—can unlock powerful improvements in mental health care, paralleling other vital competencies such as trauma-informed care. Their insights are elaborated in a thought-provoking article titled "The art of medicine: Shame competence: addressing the effects of shame in health care," recently published in *The Lancet*.

Professor Luna Dolezal, a key author of the study, highlighted that shame remains a pervasive and unacknowledged issue in health care. "Shame has been described as 'the elephant in the room' in health care—something we know exists but often choose to ignore," she stated. The concept isn’t new; concerns about shame in clinical contexts were brought to light over two decades ago by physician Frank Davidoff, but unfortunately, the situation has not changed significantly since then.

The inherent vulnerability present during clinical interactions often leads to instances of embarrassment or self-judgment for patients regarding their bodies and behaviors. Health professionals also carry their own burdens of shame, which can adversely affect their self-esteem and, ultimately, patient outcomes.

Dr. William Bynum from Duke University's Department of Family Medicine and Community Health emphasized the urgency of addressing shame in healthcare. "Patients might hide symptoms or even avoid treatment altogether out of fear of judgment, while providers risk their own mental wellbeing by not disclosing errors or compromising patient safety due to shame."

Shame competence aims to create an environment that recognizes the potential for shame while promoting constructive responses. The researchers identified five key pillars of shame competence: awareness of shame, acknowledgment of its manifestations, avoidance of shaming behaviors, providing proactive support when shame occurs, and transforming organizational culture to embed this competence in everyday practices.

Despite the inherent challenges, Professor Dolezal remains optimistic that the health care sector can effectively tackle this issue. "By developing skills and policies focused on shame competence, we can pave the way for a more empathetic and safe healthcare environment," she concluded.

Could embracing shame competence lead to radical improvements in patient care and staff satisfaction? Stay tuned as the health sector grapples with reshaping its culture in an effort to combat the hidden consequences of shame in medical practice!