Shame-based medical training teaches doctors to conceal mistakes, implying that only bad doctors make them.

Shame after a mistake is linked to higher burnout and depression in doctors.

Patients want honesty after an error, and hospitals that disclose and apologize have seen fewer lawsuits.

A culture of psychological safety helps doctors own mistakes and keep learning, which improves patient care.

One of my earliest memories of shame in medicine comes from my surgical rotation as a medical student. I woke up at 4 am to be at the hospital by 5 am to round on post-surgical patients. One morning, I forgot to put a patient's identification sticker on the progress note in their paper chart. After my presentation in front of a group of residents and students, the attending called me a "lazy doctor."

My face went hot with shame as I looked down. I had tried so hard, and I didn't know what I could have done better. I thought I had presented well and written a complete progress note. My only mistake was forgetting the sticker.

I never forgot a patient sticker again after that day. I also never forgot the shame of being called a "lazy" doctor.

That's the thing about shame-based teaching: It works—in a way. Shame made sure I never forgot again, but it also taught me that making a mistake meant I was a "bad" doctor.

I wasn't alone. Students traded stories all the time, including one about a progress note torn up in front of the group because it was "bad." Fear and shame pushed us to work harder, not because we wanted to be good doctors, but because we didn't want to be bad ones. The takeaway was that good doctors don't make mistakes; only bad doctors do.

This conditioning repeated itself for years, across medical school, hospitals, and rotations. So it's no wonder doctors hide their errors.

Unfortunately, this creates a deeper problem. If a good doctor is someone who never makes mistakes,........

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