Shame is a powerful negative emotion that motivates much intrapersonal and interpersonal conflict. The relationship between patient and physician can turn to conflict if the medical environment elicits shame in the patient; conflict arises when the patient externalizes the cause and blames the physician for negative feelings. Patients who suffer from hyperactive and reactive shame responses may require particularly sensitive care. Including the assessment of shame reactivity in the medical history can help identify such persons. Measures that reduce shame should improve compliance and reduce the incidence of malpractice suits.