BMJ 2002;324:623-624 ( 16 March )

Editorials

Shame: the elephant in the room

Managing shame is important for improving health care

The first 150 words of the full text of this article appear below.

In the 1960s the results of a large randomised controlled study by the University Group Diabetes Program showed that tolbutamide, virtually the only blood sugar lowering agent available at the time in pill form, was associated with a significant increase in mortality in patients who developed myocardial infarction. The obvious response from the medical profession should have been gratitude: here was an important way to improve the safety of clinical practice. But in fact the response was doubt, outrage, even legal proceedings against the investigators; the controversy went on for years. Why?

An important clue surfaced at the annual meeting of the American Diabetes Association soon after the study was published. During the discussion a practitioner stood up and said he simply could not, and would not, accept the findings, because admitting to his patients that he had been using an unsafe treatment would shame him in their eyes. Other . . . [Full text of this article]

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Rapid Responses:

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Yet another elephant in the room

Alastair M Hull
bmj.com, 16 Mar 2002 [Full text]

RE: "Shame: the elephant in the room"

David Rasnick
bmj.com, 17 Mar 2002 [Full text]

Re: RE: "Shame: the elephant in the room"

Craig Michael Uhl, MD
bmj.com, 18 Mar 2002 [Full text]

Re: RE: "Shame: the elephant in the room"

Gary J. Minter
bmj.com, 18 Mar 2002 [Full text]

Pride rather than shame?

melinda mary Roche
bmj.com, 22 Mar 2002 [Full text]

Let's continue this debate

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bmj.com, 19 Mar 2002 [Full text]

Shame and the courage to admit negligence

Christopher J Burns-Cox
bmj.com, 19 Mar 2002 [Full text]

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Re: Let's continue this debate

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