This article is Part 2 of our four-part series, “Treat or Be Treated: Four Common Reactions to Practice Failure in Healthcare.” In this installment, we explore the Shame Spiral—why failure feels so personal and how professionals can move beyond it. Future parts will cover the Deflection Reflex and Overcompensation leading to burnout.
The Immediate Gut Punch of Practice Failure
Picture this: You log into your practice’s bank account or receive a call from your accountant, and the numbers don’t add up. There’s a shortfall—one big enough to threaten your ability to pay staff, keep the lights on, or even remain open. That rushing, sinking sensation in your gut is the first sign of shame.
For our husband-and-wife team, discovering they had been swindled out of over a million dollars didn’t lead them to calmly strategize. Instead, they first felt humiliated, betrayed, and incompetent. They questioned every hiring decision, every expense, every aspect of their management style. In short, they questioned themselves.
Why Shame Hits Healthcare Professionals Hard
Healthcare professionals often see their work as a moral vocation rather than just a job (Ponesse, 2017). Their identity is deeply intertwined with their role: They are healers, caretakers, and trusted advisors. When the practice fails, it can feel like a failure of character or ethics—magnified by the high standards that they (and society) set for them.
- Hyper-Responsibility: Doctors, dentists, and other providers are trained to take ultimate responsibility for patient outcomes. This sense of responsibility often bleeds into business operations, making owners feel solely accountable for any financial or operational setbacks.
- Cultural Stigma: Healthcare is a highly esteemed profession. Public perception might suggest that if a medical practice fails, the professionals involved are somehow less competent or “unfit.”
- Perfectionism: Years of rigorous study and standardized exams can breed perfectionist tendencies. Failure feels not just like a setback but a personal indictment of one’s capabilities (Flett & Hewitt, 2022).
The Psychological Toll of Shame on Healthcare Professionals
Shame is more than just embarrassment; it’s a deeply internalized sense of unworthiness (Brown, 2012). When shame strikes, it often triggers a flight-or-freeze response: some practitioners become paralyzed, while others retreat from professional and personal communities.
Symptoms of the Shame Spiral in Healthcare Practices
- Isolation: Withdrawing from colleagues, friends, and family.
- Negative Self-Talk: Internal monologues filled with phrases like “I’m a failure,” “I’m not cut out for this,” or “I should have known better.”
- Avoidance of Help: Refusing mentorship, advisory boards, or peer support out of fear of judgment.
- Chronic Stress and Anxiety: Heightened stress can lead to mental health challenges, such as depression or anxiety disorders (Schneiderman, Ironson, & Siegel, 2005).
For the couple in our story, shame manifested in their reluctance to face staff members and patients. They found themselves missing important meetings, ignoring phone calls, and feigning composure. Their children noticed a marked change in their demeanor; they were no longer the engaged, enthusiastic parents who once balanced work and family so effectively.
Transforming Shame Into Reflection and Growth
The antidote to shame is often vulnerability and perspective. According to research by Dr. Brené Brown (2012), openly acknowledging setbacks and errors can mitigate the isolating effects of shame. In a business context, this means practicing the following:
- Open Communication: Speak openly with staff about the situation. This doesn’t mean disclosing every financial detail, but acknowledging a challenge and sharing a plan fosters trust.
- Seek External Input: Mentors, consultants, or even peer support groups (like local medical associations) can provide fresh perspectives and remind you that failure happens to many successful practitioners.
- Focus on Systems: Instead of framing the failure as a personal shortcoming, examine systemic issues—like insufficient internal controls, inadequate hiring protocols, or lack of financial oversight (Osterwalder & Pigneur, 2010).
Moving Beyond Shame in Healthcare Practice Management
Overcoming shame does not mean never feeling it again—it means recognizing it as a signal rather than a definition of self-worth. For our couple, the turning point came when they shifted their question from “How could we be so stupid?” to “What structures failed, and how do we fix them?” This reframing allowed them to move past self-flagellation and consider practical, tangible solutions.
However, the journey doesn’t always proceed in a linear fashion. Once you’ve acknowledged shame, the next instinct might be to deflect—and that’s precisely the subject of Part 3.
This is Part 2 of our series.. Continue reading:
