Synopsis: Many doctors believe emotion is detrimental to medical practice, and many patients think doctors are cold and emotionless. But one influential physician explains why emotion is important to doctors.

Host: Lynn Holley. Guest: Dr. Danielle Ofri, Associate Professor of Medicine, New York University School of Medicine and author, What Doctors Feel: How Emotions Affect the Practice of Medicine

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What Doctor’s Feel

Lynn Holley: Over the years, there have been many books written about what doctors think about the medical field, and what’s going through their minds as they treat patients. There’s reason for it– doctors are characteristically known for being an intelligent bunch. But regarding them as purely analytical beings misses an important part of who they are–their emotions.  Doctors are human after all, and do experience feelings like the rest of us.  But where does emotion fit in with the practice of medicine? Dr. Danielle Ofri says it’s important for doctors to retain their feelings.

Danielle Ofri: If you think about it, you know, you could probably type your symptoms into a computer and get a very precise diagnosis, but I think that most of us would not feel very well taken care of, or wouldn’t necessarily feel healed if we were treated by a computer. I think most of us would rather be taken care of by a human being. And human beings by nature have emotions in them. We can’t pretend they don’t exist. I think for the positive side of the doctor-patient connection, the emotions is what makes us different from computers, and I think that’s the difference between getting cured of an illness and the possibility of healing from an illness.

Holley: Ofri is an Associate Professor of Medicine at New York University School of Medicine, and an internist at Bellevue hospital.  She’s also author of What Doctors Feel: How Emotions Affect the Practice of Medicine. Ofri admits that many patients perceive doctors as hardened and emotionally distant as a result of years in the medical trenches. But, she says that’s not always the case.  She says that doctors do feel, and this can have an effect on how they treat patients.

Ofri: There are a few studies I was talking about in my book that interviewed, for example oncologists, who face grief and death at quite a high frequency. And they found that doctors were profoundly affected by the death of their patients. That it wasn’t routine, everyday business, just go about your life. They were genuinely sad, and they needed time to process that. Many found that if they didn’t, they would respond to their next patient differently. If they felt for example, that a patient who died didn’t get aggressive enough care they might be overaggressive with the next patient, or vice-versa: if they thought the patient had too much treatment and died with too many machines and interventions, they might undertreat the next patient. They were cognizant that the grief was affecting how they cared for their future patients. And so some hospitals have set up groups for patients, for oncologists, to meet weekly and to talk about this and to acknowledge the patients who have died, to say their name, say something about them to give grief its due. One of the take home messages I found in researching this book and talking to many, many, many doctors is that the emotions are there whether we believe in them or not they’re there. They needed to be given their due.

Holley: Throughout her book, Ofri shares her own experiences with emotions in her practice.  She admits that sometimes emotions have caused problems for her—like they did with one patient named Julia.

Ofri: She’s a young woman, and she was in her mid-thirties when we met on the wards, and i was also in my mid-thirties. We both had two young children at home, and for genetic reasons her heart was failing, and she was otherwise healthy, but it was clear that her heart was on a downward course and that she would be dead in a few years. Now, there was a cure available for this, a treatment of a potential cure, and that is a heart transplant. But the unfortunate issue was that Julia was an undocumented immigrant from Guatemala, therefore she couldn’t get on the transplant list. And I remember the first time we made her diagnosis, and realized that we couldn’t bring ourselves to tell her. Several of us doctors tried and we simply couldn’t get the words out of our mouth that you have a disease normally we could treat it, we could even cure it, but because of the randomly luck of where you were born, and your situation, we can’t offer you that treatment, and you will die, and your children will grow up without a mother.

Holley: You might wonder how some doctors would react to that. The common stereotype is that doctors are drained of empathy and compassion for patients the longer they practice.  Ofri acknowledges that it’s a problem.  But she says that it starts a lot sooner than you might think–while doctors are still in school.

Ofri: Studies have looked at medical students, and when the students come in, in first year they’re full of all the right stuff, they have come to medicine for the right reason. They’re idealistic, they care about patients, they want to help and when they leave their empathy and compassion have gone down quite a bit and when they try to drill down to when it happened seems to be in the traditional third year of medical school. Students usually spend the first two years in the classroom, and then the second two years on the wards, and in the clinics and it’s that exposure to clinical medicine that seems to do the most damage. And they often witness that many of the things they learned about, the professional ideals are dispensed with during the actualities of medical care, and this is so profoundly disheartening, and they end up imitating the role models they see.

Holley: So, what does Ofri suggest to fix the problem?

Ofri: Well, I think it starts with the mentors for the students, and that is those of us, senior positions, who work with the students. We really have to walk the walk. We can talk the talk all we want, and have great mission statements and PowerPoint presentations about compassion and empathy, but these are things that have to be demonstrated both to the patient and to the student and to the nurses and to the other staff. I think if we treat our staff and our patients with respect and with compassion then people see that.

Holley: These changes haven’t happened yet, but Ofri remains hopeful. Her message isn’t just for patients, but for doctors as well– emotions do play an important role in medicine.

Ofri: Doctors feel everything. I think that doctors are as human as their patients and emotions are like the continuous baseline that runs in the background of all of our encounters all of our actions and they influence them in ways large and small. We need to be in tune to them, because if we don’t, if we choose to ignore them, then we will miss out on an enormous portion of what’s happening between doctors and patients. It’s not that the emotional side is more important or should replace the medical care we give but it’s an integral part and parcel of the connection between doctors and patients.

Holley: For more information about Orfi’s book, “what doctors feel,” you can visit Danielle Ofri –that’s o-f-r-i–dot com. To learn more about all of our guests, you can visit radio health journal dot net.  Our production directors are Sean Waldron and Nick Hofstra. I’m Lynn Holley.

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