Clinician communication and patient shame during chronic condition management visits

Identify clinician communication that could elicit or avoid eliciting potential patient shame in the context of a chronic condition management (CCM) visit.

This study involved a multi-qualitative method observational design. We recorded 18 CCM visits in three internal medicine clinics, one family medicine clinic, and one psychiatry clinic. Patients were interviewed after CCM visits about their interpretations of clinician communication. Interviews were analyzed using deductive content analysis to explore if patients felt shame. Talk in CCM visits that could generate shame were analyzed using conversation analysis.

One out of the eighteen patients expressed feelings of being judged and becoming reserved after disclosing marijuana use during the CCM visit: indications of a shame response. We present a single case analysis of this patient case alongside a parallel case of a patient who also disclosed marijuana use but did not indicate shame. In the first case that indicated shame, the clinician consistently used "okay" that merely acknowledged receipt of information from the patient and moved to ask more questions or close discussion. The clinician also suggested the marijuana use was problematic and should be reconsidered. The clinician in the second case used continuers to encourage the patient's talk about cannabis and acknowledged their experiences and concerns without providing any assessments or recommendations.

It is possible that clinician communication may influence patient shame, especially in instances of patient disclosures of sensitive information. Further exploration of the influence of anticipatory shame on patient interpretations of clinician communication is warranted.

Clinicians must navigate the challenge of addressing sensitive topics. Creating connection and trust may be useful prior to suggesting health behavior change.