What role do negative self-conscious emotions play in UK medicine? A systematic review and qualitative synthesis of the evidence

Negative self-conscious emotions have long been theorised to play a role in medicine and this paper outlines a systematic review of empirical research that identifies qualitative data for shame, guilt, humiliation or embarrassment in doctors, patients, and students in the UK between 1979 and 2023. PubMed, PsycInfo, CINAHL plus, Web of Sciences and Medline were searched, and a total of 160 papers were identified. Only six papers set out to identify these emotions, while 154 papers had found such experiences while investigating other topics. A Framework Approach was used to create analytical themes from the information. This review provides the most comprehensive analysis of the evidence for negative self-conscious emotions in medicine to date, showing not just how it is experienced, but also how it contributes to adverse health outcomes, and compromises the quality of patient care. We demonstrate how patients experience negative self-conscious emotions as a result of feeling flawed, which can be exacerbated by insensitive treatment or a perception of judgment. Similarly, doctors can experience negative self-conscious emotions due to perceived failures in patient care or a sense of inadequacy in their role. Rather than seeing negative self-conscious emotions as products of personal circumstance or poor practice, however, our critical analysis argues that they need to be seen as inevitable experiences of the system and practice of medicine, which changes how we should understand and address these feelings in policy and practice.