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Doctors urged to be aware of patient ‘shame’ when trying to treat them

Using shame or stigma to tackle obesity or addiction as part of health campaigns can make people’s health worse.

Doctors could improve patients’ health if they were more aware of the serious impact shame has on the body, research suggests.

Studies have shown that people feeling shame avoid seeking medical treatment or telling doctors the truth about their symptoms.

Chronic shame is also associated with weight gain, heart disease, hardening of the arteries and decreased immune function.

In a new study experts at the University of Exeter have recommended doctors should be trained to become aware of the shame felt by a patient when analysing their health, and this should become part of medical practice.

The impact of shame on health means the use of shaming and stigma to tackle obesity or addiction as part of health campaigns can also make people’s health worse rather than encouraging them to live a better lifestyle, the experts have warned.

They have urged the medical profession to think again about the way they try to encourage people to make better choices.

Dr Luna Dolezal, who led the study, said: “Shame’s influence is insidious, pervasive and pernicious. It has a powerful impact on how doctors treat people and on political decisions about health.

“When individuals feel the threat of shame this can lead to failure to seek treatment.

“Failure to disclose the full details of one’s mental or physical ill-health or one’s situation or identity, for example one’s sexuality or literacy status, which may result in inadequate or ineffective treatment being prescribed.

“They may fail to complete their course of treatment and conceal a diagnosis from their family and friends.

“The use of stigma and shame in public health campaigns and as a strategy to motivate for healthy behaviours, for example, when considering conditions such as obesity, sexual health and addiction, where individuals are seen to be making ‘choices’ that affect their health status, should be carefully reconsidered.”

The study highlights how scientists have shown that shame puts a physiological strain on the body and its systems because of chronically elevated hormone levels.

Shame has also been associated with alcoholism, addiction and eating disorders, where people are trying to “numb” themselves from negative feelings.

Patients can feel shame because of their poverty, race or gender or because they feel physically or socially inadequate.

They can also feel shame because of ageing, disfigurement, infectious diseases, mental health issues, obesity or incontinence.

:: The study, Health-Related Shame: An Affective Determinant Of Health?, is published in the journal BMJ Medical Humanities.

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