Healthcare Without Shame: Addressing Stigma in Clinical Settings
- t2diabetesnetwork
- Aug 26
- 4 min read
Key Highlights:
Diabetes stigma:
✅ Is a significant barrier to care.
✅ Is linked to higher HbA1c levels.
✅ Can lead to mental health issues.
✅ Calls for compassionate provider training.
The physical demands of managing diabetes are well-documented, but for many, a significant barrier to effective care exists in the clinical setting itself: healthcare-related stigma. This shame and blame, often unintentional, can have profound and lasting negative impacts on a person's health outcomes, from mental well-being to medication adherence. It is a pervasive issue that requires a deliberate and compassionate response from every member of the healthcare team.
The Harmful Impact of Stigma on Patient Care
Research has consistently shown that when people with diabetes feel judged by their healthcare providers, they may avoid appointments, conceal self-care behaviors, and struggle with mental health. A study in the British Journal of Hospital Medicine highlights how a lack of empathy from healthcare professionals can lead individuals to not manage their diabetes as advised or even seek support.
The consequences are far-reaching:
1. Decreased Patient Activation: Self-stigma is significantly associated with lower levels of patient activation, which is a person's knowledge, skills, and confidence to manage their health. When patients internalize negative stereotypes, they are less likely to feel empowered to take an active role in their own care. This can create a vicious cycle where a lack of confidence leads to poorer management, which in turn reinforces the feeling of shame.
2. Healthcare Avoidance and Worsened Outcomes: The fear of judgment can cause a person to delay or completely avoid medical appointments. An article from the Royal College of Nursing reported that over half of patients interviewed missed appointments due to fear of stigma. This avoidance can have serious clinical consequences. Another study in eGrove found that perceived discrimination was significantly associated with a greater risk of hospitalizations and emergency department visits. When individuals only seek care during a crisis, it leads to poorer health outcomes and higher healthcare costs.
3. Poor Disease Management and Mental Health: Stigma can directly interfere with a person's ability to manage their condition. It is associated with higher HbA1c levels, which is a key measure of blood sugar control. This is often a result of patients feeling too ashamed to adhere to treatment plans openly or to discuss their struggles with their provider. The emotional toll is also immense. A meta-analysis of 19 studies involving over 12,000 participants showed a high correlation between diabetes-related stigma and psychological distress. Individuals with diabetes are at a higher risk for depression and anxiety, and stigma exacerbates these mental health challenges.
From Blame to Partnership: Strategies for Change
Fortunately, there are actionable steps healthcare providers and health systems can take to foster a more compassionate and effective clinical environment.
1. Language Matters: The words we use can either empower or alienate. The American Diabetes Association's "The Use of Language in Diabetes Care and Education" report provides critical guidance on this issue [7]. It advocates for person-first, non-judgmental, and strengths-based language. For example, using "a person with diabetes" instead of "a diabetic," and focusing on "management" instead of "control," which can imply a personal failure when targets are not met. This small but significant shift in language helps to separate a person from their disease and reduces feelings of shame.
2. Recognizing and Addressing Bias: Unconscious bias can lead to assumptions that a person's diabetes is a result of their lifestyle choices, ignoring the complex interplay of genetics, socioeconomic status, and environmental factors. Healthcare professionals must be trained to recognize their own biases and understand that stigma does not motivate people to be healthy; in fact, it has the opposite effect, increasing stress and the risk of chronic disease. Initiatives like the "Language Matters" document from Diabetes Canada can be integrated into medical training to help providers communicate in a way that builds trust and collaboration.
3. Implementing New Educational Models: Traditional medical education often focuses on the biological aspects of disease, overlooking the psychosocial burdens. New models that incorporate patient perspectives are proving effective. One study found that a contact-based educational approach, where medical students interacted with a panel of people living with diabetes, improved the students' attitudes and increased their empathy towards patients. Hearing personal stories from people who have experienced stigma firsthand can be a powerful tool for shifting perspectives and fostering a more compassionate approach to care.
Healthcare professionals play a powerful role in shaping the patient experience. Resources, like the Diabetes Stigma in Healthcare: A Resource for Healthcare Heroes, are designed to help providers move from unintentional harm to active allyship.
With practical strategies on language, empathy, and bias awareness, it empowers clinicians to build trust, foster dignity, and improve health outcomes for people living with diabetes. Together, we can transform stigma into support and ensure compassionate, person-centered care.
Find more resources and videos on Diabetes Stigma on our T2D Network Diabetes Stigma webpage.
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