Physician Danielle Ofri’s latest book, What Doctors Feel: How Emotions Affect the Practice of Medicine, is part of her ongoing attempt to bridge the patient/doctor gap, as seen in her earlier works. While this latest work focuses on the emotions doctors go through, Ofri’s point is that those emotions impact care. Learning more about what doctors feel can help, not only the medical profession, but patients as well. What becomes alarmingly clear is that little is done to help doctors deal with the range of emotions that run through them. As a result, doctors suffer burnout, patients are treated with more distance, and the medical profession as a whole suffers.
As medicine becomes more high tech, there exists the possibility that the distance will grow. Ofri cautions us not to be fooled by such possibilities: “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.”
Much of the issue is found in the training of the doctors. Ofri shares the work of the 19th century physician and teacher, Sir William Osler, who encouraged young doctors to create a distance between themselves and the patient. The idea centers around the ability to make more logical decisions when the mind is not clouded by emotion. Osler did not want the doctors to treat their patients as mere subjects, but he did not want them distracted from making clear medical decisions.
That training remains, and Ofri uses stories to tell about the times when ignoring the complete care of the patient, in the interest of medical care, led to disasters. Conversely, she shares stories of when doctors have failed to keep that emotional distance, and as a result, better decisions were made. Nevertheless, she bemoans “the consistent and depressing observation that medical students seem to lose prodigious amounts of empathy as they progress along the medical training route.”
Not surprisingly, doctors hit the normal range of emotions. Grief, joy, sadness, guilt, shame, anger, and frustration are all part of the range any normal doctor, or person, will go through. What is different, is the intensity of the emotion. If I make an error in this book review, I may feel guilty, but I do not carry the weight of causing the death of someone due to that mistake. Doctors do.
Where the book wanders at times is when Ofri focuses too much on lawsuits and medical errors. But her point in addressing those areas point out the feelings of guilt and shame that doctors experience. Our tendency to sue for every real or supposed error, contributes to our own problems in the medical world. “Unless we can somehow defuse the shame and loss of self-definition that accompany the admission of medical errors, the gut instinct to hide an error will always be the first lynx to pounce upon the heart.”
Ofri clearly wants us to address the emotional needs of doctors, for their sake and for the sake of patients. Doctors who feel safer making an emotional connection will provide better care for their patients. How we are to improve the system is not clear, but Ofri’s intent seems to simply get the issue recognized. There have been inroads made, and she highlights the work of Herdley Paolini at Florida Hospital, where they have developed a program to address the emotional needs of all their staff. But, clearly, much work remains.
While doctors and patients will benefit from reading Ofri’s work, perhaps legislators and hospital administrators, those with the most power to change the situation, should read this book. Regardless, Ofri’s point is clear. When a doctor and patient interact, they are really two humans interacting. Emotions will be part of the relationship. Perhaps we should pay more attention to what those emotions mean in the medical world.