What Doctors Feel: How Emotions Affect the Practice of Medicine

What Doctors Feel: How Emotions Affect the Practice of Medicine

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by Danielle Ofri

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A look at the emotional side of medicine—the shame, fear, anger, anxiety, empathy, and even love that affect patient care
Physicians are assumed to be objective, rational beings, easily able to detach as they guide patients and families through some of life’s most challenging moments. But doctors’ emotional


A look at the emotional side of medicine—the shame, fear, anger, anxiety, empathy, and even love that affect patient care
Physicians are assumed to be objective, rational beings, easily able to detach as they guide patients and families through some of life’s most challenging moments. But doctors’ emotional responses to the life-and-death dramas of everyday practice have a profound impact on medical care. And while much has been written about the minds and methods of the medical professionals who save our lives, precious little has been said about their emotions. In What Doctors Feel, Dr. Danielle Ofri has taken on the task of dissecting the hidden emotional responses of doctors, and how these directly influence patients.
How do the stresses of medical life—from paperwork to grueling hours to lawsuits to facing death—affect the medical care that doctors can offer their patients? Digging deep into the lives of doctors, Ofri examines the daunting range of emotions—shame, anger, empathy, frustration, hope, pride, occasionally despair, and sometimes even love—that permeate the contemporary doctor-patient connection. Drawing on scientific studies, including some surprising research, Dr. Danielle Ofri offers up an unflinching look at the impact of emotions on health care.
With her renowned eye for dramatic detail, Dr. Ofri takes us into the swirling heart of patient care, telling stories of caregivers caught up and occasionally torn down by the whirlwind life of doctoring. She admits to the humiliation of an error that nearly killed one of her patients and her forever fear of making another. She mourns when a beloved patient is denied a heart transplant. She tells the riveting stories of an intern traumatized when she is forced to let a newborn die in her arms, and of a doctor whose daily glass of wine to handle the frustrations of the ER escalates into a destructive addiction. But doctors don’t only feel fear, grief, and frustration. Ofri also reveals that doctors tell bad jokes about “toxic sock syndrome,” cope through gallows humor, find hope in impossible situations, and surrender to ecstatic happiness when they triumph over illness.  The stories here reveal the undeniable truth that emotions have a distinct effect on how doctors care for their patients. For both clinicians and patients, understanding what doctors feel can make all the difference in giving and getting the best medical care.

Editorial Reviews

Library Journal
With grace, courage, humility, and compassion, Bellevue Hospital physician Ofri (cofounder, Bellevue Literary Review; Singular Intimacies: Becoming a Doctor at Bellevue) gives voice and color to the heartbreak, stress, and joy that attends medical practice. New York-based Ofri notes that medicine is about far more then science and that a physician's vision can be sharpened or misled by emotional reactions to patients. In particular, she follows the case of a long-term patient, Julia, exploring the twists and turns of her care and how she impacted Ofri's mind and heart. While this book's best feature is its raw emotional storytelling, it also addresses the academic literature on emotions and medical decision-making without overpowering Ofri's prose or interrupting her momentum. VERDICT A moving and informative read that will appeal to both general readers of books such as Jerome Groopman's How Doctors Think or Richard Selzer's Letters to A Young Doctor and to medical students and practicing physicians.—Aaron Klink, Duke Univ., Durham, NC
Publishers Weekly
Ofri (Medicine in Translation: Journeys with My Patients) offers an eloquent and honest take on the inner life of medical professionals, describing not only her own bumpy path from med student to M.D., but also the difficulty of maintaining empathy for patients over the years. “Emotional layers” in medicine are more subtle and pervasive than anyone wants to believe, and they often become the “dominant players in medical decision-making,” she argues. Ofri uses the story of illegal immigrant Julia and her battle with congestive heart failure as a jumping-off point for discussing how doctors handle emotionally complicated cases. From the reluctance of Julia’s medical team to deliver her “death sentence” to a happy conclusion following the persistence of her hospital team, Ofri celebrates the rare occasions “of joy in our profession” while investigating the “documented decline in empathy” shown to begin in med school. Not every doctor becomes hardened, though many lose their way (the author describes an ER doc who was canned for being drunk on the job). Ofri heaps praise on one M.D. who sagely advises that “it is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” 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. (June)
From the Publisher
“Taut, vivid prose. . . . She writes for a lay audience with a practiced hand.” —New York Times

"Here is a book that is at once sad and joyful, frightening and thought-provoking.  In her lucid and passionate explanations of the important role that emotions play in the practice of medicine and in healing and health, Danielle Ofri tells stories of great importance to both doctors and patients.” —Perri Klass, author of Treatment Kind and Fair: Letters to a Young Doctor

“An invaluable guide for doctors and patients on how to ‘recognize and navigate the emotional subtexts’ of the doctor-patient relationship.” —Kirkus Reviews

“Yet her insightful and invigorating book makes the case that it’s better for patients if a physician’s emotional compass-needle points in a positive direction.” —Booklist (starred review)

“Rich and deeply insightful. . . . A fascinating journey into the heart and mind of a physician struggling to do the best for her patients while navigating an imperfect health care system.” —Boston Globe

“With grace, courage, humility, and compassion, Bellevue Hospital physician Ofri  gives voice and color to the heartbreak, stress, and joy that attends medical practice.” —Library Journal

“A fabulous read.” —Greater Good

Kirkus Reviews
Ofri (School of Medicine/New York Univ.; Medicine in Translation: Journeys with My Patients, 2011, etc.) uses her experiences as a medical student and practicing physician at Bellevue Hospital to illuminate a side of medicine infrequently addressed: the psychological toll on dedicated doctors. The author begins with the experiences of third-year medical students, as they leave the classroom for the "the ongoing bedlam" of a hospital ward. In addition to the difficult task of learning all the medical jargon, they absorb the gallows humor that helps medical professionals deal with the constant stress that goes with the territory. They must also learn how to deal with the stench of disease--which is worse in the case of the homeless--without losing sight of a patient's humanity. Ofri ably describes the sheer terror that can occur when an exhausted intern or resident faces a cardiac arrest or other emergency. She describes an incident in her own career in her first week as a medical consultant. After her beeper went off, she rushed to the bedside of the patient (with interns and residents crowding around waiting for her directions), and her mind temporarily blanked. She explains how the fear of making a wrong decision stalks even an experienced doctor, especially when overworked and tired. To function, they must be able to suppress their emotions without losing the empathetic doctor-patient connection that is an essential part of the healing process. However, the constant stress can lead to temporary or permanent doctor burnout. Ofri also deals with what happens when doctors make mistakes. The loss of self-confidence and shame they feel is scarring, even when they receive support from superiors. An invaluable guide for doctors and patients on how to "recognize and navigate the emotional subtexts" of the doctor-patient relationship.

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Read an Excerpt


Why Doctors Act That Way

The experiences of medical training and the hospital world have been extensively documented in books, television, and film. Some of this has been probing and incisive, and some has been entertaining nonsense.

Much has been written about what doctors do and how they frame their thoughts. But the emotional side of medicine—the parts that are less rational, less amenable to systematic intervention—has not been examined as thoroughly, yet it may be at least as important.

The public remains both fascinated and anxious about the medical world—a world with which everyone must eventually interact. Within this fascination is a frustration that the health-care system does not function as ideally as people would like. Despite societal pressures, legislative reforms, and legal wrangling, doctors don’t always live up to these ideals. I hope to delve beneath the cerebral side of medicine to see what actually makes MDs tick.

One might reasonably say, I don’t give a damn how my doctor feels as long as she gets me better. In straightforward medical cases, this line of thinking is probably valid. Doctors who are angry, nervous, jealous, burned out, terrified, or ashamed can usually still treat bronchitis or ankle sprains competently.

The problems arise when clinical situations are convoluted, unyielding, or overlaid with unexpected complications, medical errors, or psychological components. This is where factors other than clinical competency come into play.

At this juncture in our society’s history, nearly every patient—at least those in the developed world—can have access to the same fund of medical knowledge that doctors work from. Anyone can search WebMD for basic information or PubMed for the latest research. Medical textbooks and journals are available online. The relevant issue— the one that has the practical impact on the patient—is how doctors use that knowledge.

There has been a steady stream of research into how doctors think. In his insightful and practically titled book How Doctors Think, Jerome Groopman explored the various styles and strategies that doctors use to guide diagnosis and treatment, pointing out the flaws and strengths along the way. He studied the cognitive processes that doctors use and observed that emotions can strongly influence these thought patterns, sometimes in ways that gravely damage our patients. “Most [medical] errors are mistakes in thinking,” Groopman writes. “And part of what causes these cognitive errors is our inner feelings, feelings we do not readily admit to and often don’t even recognize.”1

Research bears this out. Positive emotions tend to be associated with a more global view of a situation (“the forest”) and more flexibility in problem solving. Negative emotions tend to diminish the importance of the bigger picture in favor of the smaller details (“the trees”). In cognitive psychology studies, subjects with negative emotions are more prone to anchoring bias—that is, latching on to a single detail at the expense of others. Anchoring bias is a potent source of diagnostic error, causing doctors to stick with an initial impression and avoid considering conflicting data. Subjects with positive emotions are also prone to bias; they are more likely to succumb to attribution bias. In medicine, this is the tendency to attribute a disease to who the patient is (a drug user, say) rather than what the situation is (exposure to bacteria, for example).

This is not to say that positive emotions are better or worse than negative emotions—both are part of the normal human spectrum. But if you consider the range of cognitive territory that doctors traverse with their patients—genetic testing, ordinary screenings, invasive procedures, ICU monitoring, and end-of-life decisions—you can appreciate how the final outcomes can be strongly influenced by a doctor’s emotional state.

Neuroscientist Antonio Damasio describes emotions as the “continuous musical line of our minds, the unstoppable humming.”3 This basso continuo thrums along while doctors make a steady stream of conscious medical decisions. How this underlying bass line affects our actions as doctors—and the net effect on our patients (and on doctors when we ourselves become patients!)—is what intrigues me.

By now, even the most hard-core, old-school doctors recognize that emotions are present in medicine at every level, but typically this is lumped in with the catch-all of stress or fatigue, with the unspoken assumption that with enough self-discipline, physicians can corral and master these irritants.

The emotional layers in medicine, however, are far more nuanced and pervasive than we may like to believe. In fact, they can often be the dominant players in medical decision-making, handily overshadowing evidenced-based medicine, clinical algorithms, quality control measures, even medical experience. And this can occur without anyone’s conscious awareness.

It could easily be argued that doctors are no more emotionally complex than accountants, plumbers, or the cable-repair guy, but the net result of doctors’ behavior—logical, emotional, irrational, or otherwise— can have life-and-death consequences for patients, which is to say, for all of us.

We all want excellent medical care for ourselves and our families, and we’d like to assume that the best care comes from the doctors with the best training, or the most experience, or the best U.S. News & World Report rating. However, the myriad effects of emotional underpinnings can confound all of these factors.

Despite this, the conventional stereotype that doctors are fairly emotionless continues to maintain its hold. Many trace this back to the eminent Canadian physician Sir William Osler, often considered the father of modern medicine for such revolutionary ideas as whisking medical students out of the staid classroom and bringing them to the bedside to learn medicine by examining actual patients. The current educational system of clinical clerkships and residency training is largely attributed to Osler, as are hundreds of snappy quotations. His continuing influence is apparent in the scores of diseases, endless libraries, and numerous medical buildings, hospital wings, societies, and awards that bear his name.

On May 1, 1889, Dr. Osler stood before the graduating medical class at the University of Pennsylvania and delivered a valedictory— and now canonical—speech entitled “Aequanimitas.”4 He stressed to these fledgling doctors that “a certain measure of insensibility is not only an advantage, but a positive necessity in the exercise of a calm judgment.”

While Osler may not have created these attitudes, he neatly encapsulated the general feeling about how doctors should behave.

Though he did warn against “hardening the human heart,” the stereotype of the detached, coolheaded physician springs from this idea of equanimity.

Popular culture has embodied this. Television doctors from Ben Casey to Gregory House are detached from their patients, lauded for their technological and diagnostic acumen. Even the selflessly idealist doctors (in Arrowsmith, Middlemarch, and Cutting for Stone) and the bitingly sarcastic doctors (in M*A*S*H, House of God, and Scrubs) maintain an equanimitous distance from their patients.

Every hospital dutifully includes the word compassion somewhere in its mission statement. Every medical school rhapsodizes about the ideals of caring. But the often unspoken (and sometimes spoken) message in the real-life trenches of medical training is that doctors shouldn’t get too emotionally involved with their patients. Emotions cloud judgment, students are told. Any component of a curriculum upon which interns slap the “touchy-feely” label is doomed in terms of attendance. Hyperefficient, technically savvy medical care is still prized over all else.

But no matter how it’s portrayed, and no matter how many high-tech tools enter the picture, the doctor-patient interaction is still primarily a human one. And when humans connect, emotions by necessity weave an underlying network. The most distant, aloof doctor is subject to the same flood of emotions as the most touchy-feely one. Emotions are in the air just as oxygen is. But how we doctors choose—or choose not—to notice and process these emotions varies greatly. And it is the patient at the other end of the relationship who is affected most by this variability.

This book is intended to shed light on the vast emotional vocabulary of medicine and how it affects the practice of medicine at all levels. Hopefully, the next time we find ourselves in a patient gown, we’ll better understand the workings of those who care for us. “Cognition and emotion are inseparable,” Groopman observes. “The two mix in every encounter with every patient.” In some scenarios, this mix is highly beneficial to patients. In others, it can be calamitous.

Understanding the positive and negative influence of emotions in the doctor-patient interaction is a crucial element in maximizing the quality of medical care. Every patient deserves the best possible care that doctors can offer. Learning to recognize and navigate the emotional subtexts is a critical tool on both sides of the exam table.

From the Hardcover edition.

Meet the Author

Danielle Ofri, MD, PhD is an associate professor of medicine at New York University School of Medicine and has cared for patients at New York’s Bellevue Hospital for more than two decades. She is the author of Singular Intimacies: Becoming a Doctor at Bellevue, Incidental Findings: Lessons from My Patients in the Art of Medicine, and Medicine in Translation: Journeys with My Patients. Dr. Ofri is a regular contributor to the New York Times’ Well blog as well as the Times’ “Science Times” section and the New England Journal of Medicine. Her writings have appeared in Best American Essays and Best American Science Writing. She is the editor in chief of the Bellevue Literary Review. Dr. Ofri lives in New York City with her husband, three children, and their loyal lab mutt.

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What Doctors Feel: How Emotions Affect the Practice of Medicine 5 out of 5 based on 0 ratings. 3 reviews.
Anonymous More than 1 year ago
I first read Dr. Ofri's insightful writings in an online article, and I knew I needed to read this book. Dr. Ofri writes openly about the feelings doctors experience, both the joyful positive ones and the shameful negative ones. I felt an immediate connection with the book and with Dr. Ofri, whom I've never met, as like her, I have lived and continue to live in this culture of medicine. In this book, Dr. Ofri beautifully shares her experiences and those of other doctors as they grow from being medical students (when they were still normal human beings) to being residents (trying so hard to prove themselves worthy of joining the ranks of their mentors and instructors) to independent self-sufficient "real" doctors capable of calling all the shots and saving lives. Throughout these stages, there are overwhelming emotions that are tamped down and minimized, hidden from others, denied even to themselves, and muddled together with experiences that ultimately damage the spirit of the person known as "doctor." Dr. Ofri also shares the joy we feel when our patients are healthy, when they recover from illness, when they "beat the odds," when they allow us into their lives and hearts so that we may know them and their struggles intimately. She illustrates beautifully the bond between doctor and patient that so many of us yearn to build and rejoice in discovering. She also points out that in most cases our patients are unaware of how their lives and conditions affect us as human beings, how we hope for their sufferings to end, that we pray for them to overcome their struggles and be at peace. I've learned a lot about my doctor culture by reading this book. I've begun to allow myself to feel more, to share more, to open up more, with myself and others with regard to my experiences in medicine.
Anonymous 11 days ago
I certainly will not take my doctor for granted anymore. I recommend this book very highly.
Anonymous More than 1 year ago
Empathic journey of doctor's own feeling points, highs and lows, including well-researched experiences of peers and patients. Impacts of feelings upon both is exlplored in depth with intriging stories.