The experience of feeling stigmatised and humiliated by someone you see to attend to your health is shockingly common: A 2009 survey of more than 900 patients by researcher Christine Harris, PhD found that half of the respondents had felt shamed by a doctor, with the top two reasons being judgment about their weight and judgment about their smoking.
A more recent study by Harris found that among uni-aged students, sex and oral health were the top issues they felt shamed about. Participants in both studies also reported feeling stigmatised about mental health, failure to exercise enough, not following medication recommendations, and alcohol use. And a glance at any Facebook group for new mums will show plenty of women who felt patient-shamed after asking for pain meds during labour or for not breastfeeding their babies.
Ironically, medical shaming is more common around the very issues that require extra sensitivity in discussing—weight, sexually transmitted infections (STIs), and mental health conditions. People work up the courage to go to a doctor for help with something they may already feel embarrassed or scared about and end up having their own harmful self-judgment and fears reinforced by someone in a position of authority. The negative experience leaves them less likely to bring up problems in the future, putting their health further at risk.
Patient shaming—also known as medical bias or medical stigma—can take many forms, including disbelief of the patient and the use of demeaning language.
There are, of course, situations in which patients feel embarrassed even though a doctor isn’t shaming them. We’ve all gone red-faced while having to answer intimate questions or hearing that we’re in a high-risk category for a condition related to a controllable factor—your gums don’t lie, and it never feels good to have your dentist tell you you’re not flossing enough.
But awkwardness or disappointment is different from feeling shamed, when it seems as if the doctor is chastising or blaming you rather than speaking from a place of concern. Skilled health care professionals don’t gloss over the medical reality, even if it’s hard to hear, but communicate the facts respectfully. If information is delivered judgmentally or without basic sensitivity, a practitioner has crossed the line into shaming, says Dr Fatima Cody Stanford, an obesity medicine doctor, who has researched weight bias.
The dangers of finger-wagging
These stigmatising encounters aren’t simply upsetting in the moment—they can have lasting negative effects. Of those who reported being shamed in Harris’s study, 45% reacted by avoiding the doctor or lying about their health in future visits. At its most basic level, medical shaming erodes the trust that is the foundation of a positive patient-doctor relationship and successful treatment.
“Patients can sense whether a doctor cares, and when there’s bias, there is mistrust, so people avoid preventive visits and only come in at the last minute, when they’re in dire straits,” says Dr Stanford, who adds that implicit bias—signals given through factors like whether an office has chairs large enough to accommodate a patient with obesity or a blood pressure cuff that can fit a large arm—also sends powerful messages about how a patient is valued, even before they meet with the doctor.
After an upsetting visit, a patient shamed for being heavy, for example, may be at higher risk for anxiety, depression, and unhealthy behaviours, which can further affect their health. Research by Rebecca Puhl PhD has found that some patients cope with weight shaming by binge eating.
“Stigma is stressful, and it’s common for people to turn to food as a temporary coping mechanism,” says Puhl. The stress of weight stigma can cause an increase in a patient’s cortisol levels, a known contributor to obesity. One study found that 69% of patients classified as obese or overweight had experienced weight stigma from a doctor. And research shows that if they internalise it (meaning it affects how they value themselves), they may have higher incidences of binge eating and higher levels of C-reactive protein (CRP), cortisol, and triglycerides—markers for chronic health conditions such as heart disease and stroke, says Dr Stanford. In short, medical weight shaming can cause physical harm and make a person less likely to seek treatment.
But weight stigma is only one kind of stigma women experience at doctors’ offices. “At 16, I developed symptoms of an STI,” says Jenelle Marie Pierce, 38. “My mum took me to our family GP, who looked at my sore, took a culture, then came back in and said, ‘This is herpes; this is the worst case I’ve ever seen. Here’s your prescription for Valtrex.’ He made me feel like damaged goods. On the ride home I was inconsolable, telling my mother that no one would ever love me,” recalls Pierce, who didn’t tell future doctors of her diagnosis. “It changed how I saw myself and tempered how I sought care—I often didn’t disclose my STI at other health care visits or advocate for my needs,” she says. “It wasn’t until I went to a Family Planning organisation in my 20s that I began to feel different about myself. The doctors there were empathetic, and they gave me resources and a new perspective.”
In 2012 Pierce founded the STI Project, an educational resource committed to overcoming the stigma of sexually transmitted infections. The project “surveyed over 350 people of all ages and discovered that 30% had had a negative interaction with their doctor around their STI diagnosis, including comments laced with stigma and scare tactics along with a lack of medically accurate information about STIs, leaving them feeling ashamed and unsure how to care for themselves,” Pierce says. “And a bad medical experience may affect whether a person will disclose their STI to their partner.”
This means the potential for less frequent testing, increased transmission rates, and fewer timely medical interventions as well as the possibility of long-term problems and higher medical costs, she adds.
Stigma is sticky
With all the research showing the harmful consequences of medical stigma, why is it still so common? For starters, all of us, including doctors, live in a biased world. “These attitudes persist in our society, and doctors are not immune to them,” says Puhl.
Research shows that doctors’ levels of weight bias and mental illness bias reflect those of the general population. “We all have biases that are hardwired, and if we aren’t aware of them, they become reflexive,” says primary care and population health expert, Dr Lars Osterberg.
Additionally, some medical schools aren’t adequately training students in conditions, such as sexual health problems, that are routinely stigmatised. The same is true of obesity education. Just over 50 doctors in the entire country have completed fellowships in obesity medicine, says Dr Stanford.
“The lack of knowledge and sensitivity can be a destructive combination.”
“Medical students learn about diabetes, heart disease, even rare diseases, but there’s very little education on obesity, which approximately 31% of Australian adults have. If doctors believe obesity is simply the result of eating too much and not exercising enough,” she says, they become frustrated and often assume patients are simply non-compliant and lazy and judge them for “not controlling” their eating.
In fact, says Dr Stanford, obesity is far more complicated, and diet and exercise are usually not enough to change it. Without full understanding, practitioners may not extend the compassion patients deserve. “The lack of knowledge and sensitivity can be a destructive combination,” she says.
Doctors in training may also pick up biases from attending doctors. “Students learn working side by side with experienced doctors at patients’ bedsides in teaching hospitals. These doctors stay in their profession for years, and they may not be up on the same enlightened concepts being taught to our medical students,” says Dr Diane Rachel Fingold, an instructor who has helped redesign curriculums to integrate nonjudgmental approaches. “Those of us who do a lot of teaching in the classroom will teach students to say ‘alcohol use disorder’ versus ‘alcoholic,’ for example, so as not to stigmatise the patient. But for doctors who are only teaching in the hospital, it’s harder to keep them updated,” she says.
A 2015 study by researchers Puhl and Dr Sean Phelan, found that the more time students spent working with attending doctors who had bias against heavier patients, the more negative attitudes they were exposed to and the more their own explicit biases increased, a pattern that holds true for many conditions.
Teaching respect
As with all bias, change in this realm doesn’t happen overnight, and it requires hard work, which medical schools and universities are increasingly taking on to help their graduates offer more sensitive care.
But educators and advocates admit that they have more work to do. “It’s not enough to just teach it in medical school,” says Dr Fidencio Saldana. “We must integrate bias training across the continuum in residency programs, licensing boards, and hospital settings—giving doctors a booster shot, so to speak.”
How to protect yourself from medical shaming
It’s fine to simply get through an appointment as quickly as possible—there’s no wrong way to take care of yourself in a situation with an uneven power dynamic. But if you’d like to make the most of the visit, take these steps:
✔️ Redirect the conversation.
If the doc speaks disparagingly or raises a topic not related to the visit (say, your weight), try, “That’s not the reason I’m here. Can we go back to my tennis elbow?”
✔️ Point out the possibility of bias.
You can alert the provider that you’re feeling dismissed by saying, “I’d like to know you are taking me seriously.” Or you can respectfully call them out: “You may not intend this, but when you say X, you’re making an assumption about me that isn’t accurate.” You can also pose a question in a way that reveals the bias. For example: “Is this the advice you would give to a thin/young/male person?”
✔️ End the appointment—or make it your last.
If you’re so uncomfortable that you no longer wish to be in the same room with the doctor/nurse/dentist, curtail the visit. “Don’t forget, you’re paying for a service. If you don’t like how you’re treated, you have the right to seek out a different provider,” says Jenelle Pierce.
✔️ File a formal complaint.
Many doctors’ offices, medical groups, and hospitals have ways for patients to speak up (anonymously or not); ask the office manager how. And if the experience affected your care, consider complaining to your state’s medical licensing board.
✔️ Go to a specialist.
Seeking out a provider who’s specifically trained in the condition you need treatment for can lower the chances of stigmatisation, as specialists are more likely to understand the challenges and may be better able to provide scientifically accurate information—in short, less judgment and more support.
This article originally appeared in the July 2021 issue of Prevention USA.
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