Sunday, December 06, 2015

Do doctors have feelings?

How could I not be intrigued by a doctor's attempt to share the emotional ups and downs of her profession? After all, most of us only encounter docs when we're in the grip of our own ups and downs, usually the latter. So what goes on within those usually authoritative even if genial people wearing the white coats? Dr. Danielle Ofri offers some answers in What Doctors Feel: How Emotions Affect the Practice of Medicine.

I was easily inclined to like Ofri: she draws upon her experience practicing at Bellevue Hospital (New York City's enormous charity facility) among Spanish-speaking patients. Many years ago, I collected all too much experience transporting and assisting indigent and desperate residents of the then-impoverished Lower East Side to the very ER where she learned medicine. I was a patient there myself at least once. The docs always seemed to do the best they could -- respectfully at that -- amid the chaos.

Ofri is at her most interesting when she tries to discern what it is about the training of doctors that measurably encourages newly minted professionals to shut down their own feelings in response to their patients' troubles. Stress, insane work hours, heavy responsibility, and the need to slough off repeated exposure to ugly human realities are obvious factors. She cites studies of the nature of empathy and reports a definition I find clarifying:

... sympathy is an emotion, actually feeling the patient’s feelings. Empathy is a cognition, a thought process that allows you to understand the patient’s feelings while not necessarily feeling them yourself. In fact, maintaining your own sense of self is a key part of empathy. The empathy definition might thus be reworded as the ability to stand in another’s shoes without actually leaving your own shoes.

She describes a pilot program in which inexperienced medical personnel discussed feelings so as to learn to use the empathy they felt for patients' benefit without succumbing to overload and cynicism. She evaluates it as has having some success.

Her topics include what doctors do with the grief that conscientious ones feel when patients die. Here's Ofri describing her own feelings about forming new medical relationships after the death of a sympathetic long time patient.

I didn’t want to start again — meeting someone I would likely lose, forming one more memory ... — but of course I had to. I knew that. I recalled what a colleague once told me as I was contemplating having a second child. My first child occupied every ounce of my love and my energy, and finding emotional space for another seemed impossible. My colleague — a wise physician and a father of three — reassured me. “Your capacity simply expands,” he told me. “Your heart grows bigger and there is enough room to love more.”

... In some ways, grief is an aspect of love, a reflection of the ability to connect. As the heart can grow bigger to allow more love, it can also do so for grief. I don’t want any more of my patients to die, but I know that they will. And although I don’t want more grief in my life, I know that the connections that permit grief to occur are the connections that keep us — doctors and patients — alive. ...

Attractive and self-revealing as Dr. Ofri's descriptions of her own feelings make her, I was surprised by how little I could sympathize with her distress about being sued by former patients, something that she documents that 99 percent of doctors will experience during their careers. I just can't be surprised that this happens, even to very good doctors. Patients feel so little power in their relationships with the medical profession that it is almost inevitable that some will turn to the courts to reassert their autonomy, even if they don't have a case. Ofri says most of these lawsuits eventually go away without judgement. But she complains:

Nearly every doctor feels both her competence and her identity as a doctor challenged, even if the suit is entirely frivolous. The sense of being judged on the essence of who you are can override the facts of a given case. ...

... the assault on integrity was all-encompassing. Not a single accused doctor emerged unscathed. Even those who knew they had done nothing wrong, even those who were vindicated, suffered wrenching anguish. If it were just bad doctors who were being sued, doctors who practiced substandard medicine or who were arrogant, unfeeling, and uncommunicative, it would be one thing. But just as many suits involved doctors who had long-term, trusting relationships with their patients. Good communication and trust might decrease the number of lawsuits, but it certainly didn’t prevent them. Plenty of good and caring doctors found themselves in receipt of one of those dreaded certified letters.

I can only attribute what I read as the doctors' exaggerated whining in response to litigious patients (and families) as evidence that they just don't get it: as patients, we're scared, feel helpless, and profoundly disempowered. Some of us, if we have the chance -- if our maladies don't kill us or leave us witless -- will strike out at the available authority. We will strike out at the very people who saved our lives.

If doctors hadn't cauterized their human feelings, they might understand that. Not a good state of affairs all around, but there it is.

1 comment:

Hattie said...

One of my closest friends is a doctor who just faced a terrifying health emergency with courage and grace. He is also the most ethical person I know. It is exactly his high ethical standards that might make him seem standoffish to some, but he never forgets his calling, which is to do his best for his patients. He is very empathetic and to my knowledge he has never been sued. I know other doctors less principled, who gossip about patients and make fun of them, unfortunately. Dr. Grumpy may be amusing, but you really wouldn't want him to be your doctor.

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