“What Doctors Feel” Matters, Says Dr. Danielle Ofri

From Dr. Danielle Ofri’s What Doctors Feel

Medical students, for all of their competence and competitiveness, are a pretty fearful bunch, more so than the general population and even more than their age-matched peers pursuing other professions. Some of this is not surprising. You really should possess some fear as you begin to jab sharp objects into other people’s bodies, prescribe potentially lethal medicines, or initiate treatments that put lives at risk. Any medical student without fear is a cavalier cowboy better suited to a desk job.
But the fears can easily spiral out of control and overwhelm students and interns. If this happened only rarely, to only those few who entered the medical field with their own preexisting mental-health conditions, that would be one thing. But the truth is that the fear overwhelms even the most psychologically sound and well-adjusted trainee. At some point it happens to nearly every single person who travels through the medical training process. If you don’t believe me, just ask any doctor you know. 

Fear and sheer terror. Also: Sadness and sorrow…Empathy…Anger, grief, despair…Shame, disillusionment…Hope, love, joy…Pride, gratitude, humility. In What Doctors Feel: How Emotions Affect the Practice of Medicine hospital-based internist Dr. Danielle Ofri admits all of these types of feelings are experienced regularly by her and others in the medical profession.

How would most patients know that? They wouldn’t. Thus, we need somebody like Ofri to tell us. Last year she wrote in The New York Times, “By now, even the most hard-core, old-school doctors recognize that emotions are present in medicine at every level, but the consideration of them rarely makes it into medical school curriculums, let alone professional charters. Typically, feelings are lumped into the catch-all of stress or fatigue, with the unspoken assumption that with enough gumption these irritants can be corralled.”

It’s not that most doctors can’t do their jobs because they have emotions, it’s that doctors need to recognize they have them and not let certain ones affect the care they provide.

Ofri reports research on empathy, for example, showing that it steadily declines in doctors as early as medical school. A depressing thought, but an understandable side effect of dealing continually with difficult, often life-threatening, dilemmas. Gradually, the students’ (and later full-fledged doctors’) consequent suppression of feelings blunts their ability to empathize.

Selected Quotes from What Doctors Feel

Thus, whatever the medical student has been taught, and even genuinely believes, about the ideals of medicine, the primacy of empathy, the value of the doctor-patient relationship–all of this is swamped once he or she steps into the wards. […] It’s no wonder that empathy gets trounced in the actual world of clinical medicine; everything that empathy requires seems to detract from daily survival.

Fear is a primal emotion in medicine. Every doctor can tell you of times when she or he was terrified; most can list more episodes than you might wish to hear. […] It may be sublimated at times, it may wax and wane, but the fear of harming your patients never departs; it is inextricably linked to the practice of medicine.

How the sadness is handled by the physician has a powerful impact on the medical care received by the patients. If the grief is relentlessly suppressed…the result can be a numb physician who is unable to invest in a new patient. This lack of investment can lead to rote medical care–impersonal at best, shoddy at worst. At the other end of the spectrum is the doctor who is inundated with grief and can’t function because of the overwhelming sorrow. Burnout is significant in both these cases, and that erodes the quality of medical care.

Publishers Weekly: “Ofri’s passionate examination of her own fears and doubts alongside broader concerns within the medical field should be eye-opening for the public—and required reading for medical students.”

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