Just Read: What Doctors Feel, How Emotions Affect the Practice of Medicine

Maybe someday, When I look back I’ll be able to say, You didn’t mean to be cruel, Somebody hurt you too – “Oh Father, Madonna”

I’ve noticed in my personal and professional journey that it’s challenging for people to understand doctors.

This book helps.

I was referred to it by an influential physician leader in my life (Walking and Talking about Physician Wellness with Dawn Clark, MD, Physician Chief Wellness Facilitator), as the medical profession works to understand how to make itself to be more resilient in service to humanity.

I don’t think understanding physicians should be a prerequisite for receiving compassionate care. However/and, in working to lead with physicians or create the physicians of tomorrow, a little understanding goes a long way.

It starts with feeling unnecessary

I especially liked the description and insights about medical training, put in words that I haven’t been able to describe. On the transition to the very stable first two years of medical school to the very different last two:

To add to their discomfort, the students are astute enough to know that they don’t actually have any real purpose on the wards, no definitive job description like the doctors, nurses, pharmacists, phlebotomists, respiratory therapists, X-ray technicians, clerks, orderlies, dietitians, housekeepers, and electricians. Medical students are there only to learn. The inherently self-centered nature of their existence in a setting that is not specifically designed for their education— as the classroom part of medical school had been— creates an intensely uncomfortable state of being.

Ofri, Danielle (2013-06-04). What Doctors Feel: How Emotions Affect the Practice of Medicine (p. 32). Beacon Press. Kindle Edition.

This is really tip-of-iceberg kind of stuff, as the stages of physician training are discussed, and the various traumas embedded within (and Ofri states at the end: “In this book, I’ve focused mainly on emotions that are often called negative— fear, shame, grief, anger, being overwhelmed— because these are the ones that exert the strongest influence on medical care.” Ofri, Danielle (2013-06-04). What Doctors Feel: How Emotions Affect the Practice of Medicine (p. 210). Beacon Press. Kindle Edition.)

The failures that cause us to fail our patients

One of the stories that gripped me was the one about the author being yelled at in the Emergency Room by a supervising resident, while she was with an intern, who she was herself supervising:

“What were you thinking?” she repeated, her voice now thundering through the ER, despite the pandemonium swelling around us. Lives were at stake left and right, and she clearly wasn’t going to let me get out of this. I couldn’t even muster a whisper, knowing that my intern, who had nodded so trustingly at my earlier pronouncements, was standing not four inches from me. Scrub-clad bodies were jostling against me in the cramped space of the ER, but I felt a gulf widen around me, as though I’d just lost control of my bladder and was standing in an ever-growing puddle of mortification. My cognitive functions ground to a halt, and for the life of me I could not produce a monosyllabic response, much less an intelligent explanation.

Ofri, Danielle (2013-06-04). What Doctors Feel: How Emotions Affect the Practice of Medicine (p. 126). Beacon Press. Kindle Edition.

The story leads into a discussion about shame and the experience of failing. However, what I was also waiting to learn about was about the experience of verbally assaulting a trainee (student, colleague) and the impact of being verbally assaulted, but it never came.

Even later, as the author describes seeing her supervising resident in another context later in life (as a fellow patient, both waiting to give birth), there was no discussion of closure or evaluation of this incident as perhaps the bigger failure.

As I was reading this, I paged back through my mind at the times I may have been treated similarly or seen similar treatment in my career, and I keep coming back to those incidents as the failures, rather than the missed medication or some other things I have seen that are out of scope for this blog post. Some humans are able to cope and adapt over time (including via writing books) and some are unable. As I’ve said previously, some are misfits, some “fit in.” Which is better….this story helps answer that question.

This is not the patients’ fault, and to an extent, it is not their problem to solve, especially since they didn’t create it, and it’s all unnecessary. As the proctor for one of my board exams once said to a huge auditorium full of us medical students once, “Remember in your careers that it takes just as much energy to be nice as it does to be mean.” And I remembered. Actually, she was wrong. It takes more energy to be mean.

“It is better to fail at your own dharma than to succeed at the dharma of someone else.”

Interestingly, another influential person in my life (@KristinJuel) referred this book, Stephen Cope, The Great Work of Your Life: A Guide for the Journey to Your True Calling, to me at the same time, which I read concurrently, and where there’s significant crossover.

There may be a lot of root cause in the results of medical training in the ways people come to, and exist in medical training.

Since I also enjoy documenting the world around me, I took the opportunity to go to the places to see and learn about people who followed their own dharma, such as Harriett Tubman, because I can (❤️ DC):

Photo Friday: Harriet Tubman’s Underground Railroad Byway & Visitor Center, Maryland, USA

Or Jean-Baptist-Camille Corot

As I read both books in tandem, I reflected on myself and the people I have known in medicine and what their dharma may or may not be. For some it is medicine, for some, it is clearly not, and that’s a difficult situation for everyone. Ofri’s work reminds that we should open up this dialogue rather than face the consequences later.

Of course, most doctors are not aware of the underlying emotions that are influencing their behavior; they are simply reacting to their instincts, which often tell them that it’s better to let sleeping dogs lie and just get on with the job. The sleeping dogs, though, have the potential to wake up, and the patient might be the one who gets bitten.

Ofri, Danielle (2013-06-04). What Doctors Feel: How Emotions Affect the Practice of Medicine (p. 133). Beacon Press. Kindle Edition.

Getting what we bargained for

Other doctors talk about external stressors that diminish the otherwise enjoyable experience of caring for patients— administrative headaches, time pressures, financial squeezes, family strains. But these all have in common the feeling of “This isn’t what I bargained for when I started medical school.” And they also have in common that patients feel the effects— whether subtle or major. Any doctor who is feeling anger at patients, or frustration, or boredom probably isn’t doing as good a job as he could be, and may, in fact, be causing harm.

Ofri, Danielle (2013-06-04). What Doctors Feel: How Emotions Affect the Practice of Medicine (p. 150). Beacon Press. Kindle Edition.

Really, who goes into medicine or anything in life bargaining to experience disrespect, misogyny, homophobia, transphobia, and a host of other inhuman behaviors so that they can support others’ humanity? Many of us would prefer a re-negotiation of that bargain 🙂 .

Ofri is a sensitive documenter of the stories she tells of herself and colleagues and in my opinion she’s helping with the renegotiation of the bargain through her writing, which I can imagine is as therapeutic for her as it is for her audience.

I suppose many of us do various things to renegotiate the bargain every day and that’s been a great finding for me: The bargain can be renegotiated, because our generation came to medicine to change everything, and there are lots of influential people around us to make it so.

Ted Eytan, MD