Years ago, time has somewhat lessened the sting, a patient of mine experienced a serious complication during an anaesthetic. I still hear his voice ringing through the ward: “What kind of doctor are you?!” he shouted, glaring me at as I stood by his bedside afterward.
Though the complication was very unfortunate, it wasn’t due to negligence or carelessness. In the days and weeks that followed, I struggled to process what had happened. The guilt over the patient’s experience was difficult, but what lingered was shame. I wasn’t only questioning my actions, I was questioning who I was as a clinician.
Dr. Will Bynum, a physician and shame researcher at Duke University, draws an important distinction between guilt and shame. Guilt is about what we did—“I made a mistake.” Shame is about who we are—“I am the mistake.” The difference seems trivial but has huge consequences. Dr. Bynum’s work shows that many clinicians internalise mistakes. We don’t just reflect on what went wrong, we see it as proof that we’re not good enough. We jump from “I missed something” to “I’m incompetent.”
The tide is slowly turning, but the culture of medicine still sends the message that errors are unacceptable and uncertainty is weakness. We reward perfection, not vulnerability or reflection. When things go wrong, how many of us have heard these voices inside our heads?
“I feel like a fraud.”
“I don’t belong here.”
“I am not good enough.”
This inner dialogue is rarely shared aloud, but it becomes a heavy burden. The outcomes of guilt and shame thus diverge. Guilt, though uncomfortable, can be productive and motivate growth. It pushes us to reflect, change, and do better next time. Shame, on the other hand, shuts us down. It leads to hiding, avoidance, and self-doubt. It hinders learning, and damages our wellbeing and ability to care for patients.
The poet and songwriter Leonard Cohen wrote, ”There is a crack in everything / That’s how the light gets in.” In medicine, that “crack” may be a misdiagnosis, a failed exam, or perhaps a procedural complication. Whether that crack lets in light or shuts out hope depends on how we interpret it. Do we see it as evidence of our unworthiness, or as a painful but necessary step towards becoming better clinicians?
Psychologist Carol Dweck’s concept of the growth mindset is especially relevant here. It is the belief that ability and intelligence are developed through effort and learning. In a growth mindset, setbacks aren’t evidence of failure, but opportunities for improvement. This is especially powerful when modelled by senior staff. The simple acknowledgement “I have made that mistake too” sends a message that true excellence is being willing to grow through failure, it doesn’t require the absence of failure. This openness invites junior staff to be honest and reflective, rather than silenced by shame. Reframing critical incidents as painful but essential learning moments can mean the difference between a downward spiral and resilience.
We often talk about empathy and compassion for our patients and colleagues. Ironically, many of us are poorest at offering that same compassion inward. Self-compassion is not indulgent, it is essential to human sustainability. It does not absolve responsibility. It allows us to own our mistakes without being crushed by them, and saying: “I made an error. What can I learn from this? What can I do to make it right?” A helpful reference in these moments: “What would I say to a colleague in this situation?” Chances are, you would offer them kindness, perspective, and encouragement. We should offer ourselves the same.
I regret my patient’s suffering. I debriefed the clinical details with colleagues and visited him in the ward until he stabilised. I also know that I did the best I could at the time. Now, with the light of experience and insight let in through that crack, I’m better prepared for the next time.
Dr Alina Tan, Deputy Chief Wellbeing Officer, National University Health System, and Senior Resident Physician, Department of Anaesthesia, National University Hopsital, Singapore
alinatandr@gmail.com.
1st October 2025
