The crowded consulting room: Shame as an accumulated life course process in primary care.

Although shame is recognised as a powerful force in clinical settings, it may be understood as an individual emotion and an episodic experience. Drawing on life course theory and narrative analysis, this paper examines how shame creates a barrier to engaging with health care. We analysed 32 stories submitted by older people to an anonymous online story-sharing platform in Aotearoa New Zealand during 2024, in which participants described times they felt too embarrassed or ashamed to seek health care. Participants described experiences of dismissal, disbelief, and moral judgment, with past encounters shaping anticipation of future care. Accounts were situated within shifting health care discourses that promised patient empowerment while continuing to enact hierarchical authority in practice. Dismissal and disbelief were viewed as strategies to bolster medical authority, practices which ironically contributed to scepticism and rejection of medicine. Agency was narrated as a constrained response: participants rejected being positioned as shameful, persisted in seeking recognition and responsive care, but often withdrew after repeated episodes of dismissal. These accumulated experiences shape trust, credibility, and willingness to engage with care. This analysis highlights the need for primary care practitioners to recognise that consultations are shaped by accumulated histories, not solely by presenting concerns. In doing so, it foregrounds shame as a structurally produced affective process, shaped by medical authority and irreducible to individual encounters or to physician communication style.