Shame and Medicine Exeter
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The clothes of shame

A knotted gut.


Intense self-loathing.

Wanting to hide.

Ruminating and agonising for days.

Rationalisation and learning.


These familiar and habitual sensations, behaviours and outcomes accompanied times of perceived failure and humiliation; ranging from school, such as when being interrogated to the point of tears in mathematics, through veterinary and specialist training when I had made a ‘mistake’, my first PhD viva, and even ‘Reviewer 2’ comments.

Before my development as a coach, when I was ‘just a vet’, I did not have the emotional awareness to name these experiences as shame. From then, however, I began to identify how the need to avoid the pain and discomfort of shame motivated my career, and life, choices.

Vet is even more difficult to get into than medicine, isn’t it!’, ‘Vets train even longer than doctors, don’t you?’ (not true!), ‘Your patients can’t tell you what’s wrong!’. Comments that were grist to the mill; through becoming a vet I could be above criticism (also not true). Unconscious protection afforded by the clothes of professional identity, facilitated by intellect, and fuelled by the thrill of learning and mastery, drove the growth and refinement of a persona; specialist training, a Masters, a PhD, building a clinical service, joining committees, developing expertise, reputation, recognition, and status. I sacrificed connection, relationships, emotion, and wholeness as I drove myself on, saying over and over ‘It’s a marathon not a sprint’ and comparing my achievements to others’. Yet each milestone met did not reduce my sensitivity to shame and its pain – my defences just kept building.

Self-compassion developed and shame reduced through relationships. Clinical insights, rare diagnoses, and elegant therapies became more day-to-day and less validating. Deeper satisfaction came from co-creating ‘good enough’ solutions without perfect outcomes, easing pain and improving qualities of life, as well as teaching and developing others. These skills, honed in clinics, were preparation for clinical and business leadership relationships and I became interested in what motivated myself and others. Why and how did I respond this way? Why did leading and managing a veterinary practice feel so hard at times?

My interest in coaching developed in leadership training and I enrolled for a Master’s. This was revelatory. Encouraged to grow self-awareness- cognitive, embodied and intuitive- in and out of the coaching room, I developed a greater appreciation of intra- and inter-personal psychology and of factors which created my scripts, motivations, and behaviours, including shame sensitivity. Peers without preconceptions, who cared little about my veterinary professional identity, and who were curious about my whole person, held safe spaces that allowed me to explore, understand and forgive. I identified my shame experiences and worked on self-compassion. As I reconnected with my whole self I recognised a weave of curiosity, creativity, compassion, and empathy which had softened the edges of my intellectual pursuits. I had been much too hard on myself, and I could be proud of my accomplishments.

Shame begets shame and I sense that clinical environments are full of shame. Shaming behaviours are common; blame, ridicule, incivility and impatience accompany competition for resources, recognition, and reward. Yet shame is not in the collective consciousness. We rarely name it or recognise its power. Is there a blind spot about shame, the unknown unknown, which makes even acknowledging and addressing it, shameful? Does it provoke defensive responses when there is a sense of criticism or of failure? Responses such as disengagement, resistance, anger, or the intellectual demand for ‘evidence’ that were familiar currency in my clinical leadership role, positive feedback loops which triggered shame in me (typically self-absorption, self-criticism, and withdrawal) and which I interpreted as hard without clear understanding of, or the ability to name, emotions in the here-and-now. Does the shame of failure, ingrained through clinical training and professional identity development, create uncomfortable tensions in the complex, messy and imperfect world of leadership? Is that one of the reasons many clinicians seemed reluctant to pursue formal leadership roles?

What, on the other hand, has shame has given me? By driving my clinical development and practice, I was able to care for my patients, care for their carers, mentor, teach and develop. By commonly accepted measures I was ‘successful’. Could I have been as effective without shame on my shoulder? I believe so and, with early compassionate support and mentorship, my clinical career could have had the same outcomes with a different experience, with wider, more fulfilling, and sustained relationships. I am grateful, therefore, we are opening these conversations, developing awareness of our frailties, appreciating the importance of compassion, and celebrating that we are, above all, human.

This poem by Khalil Gibran, ‘On Clothes’ speaks to my experience


Dr Clive Elwood MA VetMB MSc MS(Ashridge) PhD FRCVS

7th February 2023

Photo by Online Marketing on Unsplash









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