It used to be common for physicians to give common-sense advice to patients; lose weight, drink less alcohol, stop smoking.

Such shaming may reflect an unequal power relationship, according to a paper in Humanities and Social Sciences Communications which also argues that such shame may create a barrier to accessing services, a fear of being judged, circumstances, coping behaviors, body, illnesses, along with other vulnerabilities.

The humanities scholars that medical professionals should also be trained to have “shame competence” and teach a theoretical and practical understanding of what shame is, how it operates, how it is evoked, how it can be hidden, and understand the behaviors that are used to cope with shame.

The study says doctors, social workers and other care professionals should become aware of common verbal and nonverbal cues that may indicate shame. This includes physical tics such as covering the face, blushing and downcast eyes. They should also be aware of words people us instead of shame - self-conscious’, ‘embarrassed’, ‘foolish’, ‘worthless’, ‘inept’, ‘inferior’ and stammering, silence, long pauses. They must remain alert to, and continuously assess, how the language they use, their demeanor, questioning style, emotional expression and other interpersonal dynamics may inadvertently produce a shame response. Organizations must also continuously assess for implicit and explicit shaming, endeavoring to eliminate intentional or inadvertent shaming from their policies and practices.

“Using a ‘shame lens’ can help those who work with people to redesign services to be more sensitive and supportive, with the ultimate aim of avoiding additional trauma and harm,” says Matthew Gibson, PhD in social work at the University of Birmingham.