My Assumptions about Emotions in the Clinical Context • Being aware of and able to modulate and manage emotions in self and others is essential in good patient care • A competent physician must be able not only to diagnose biological disease but also to distinguish/cope with the patient’s (and his/her own) feelings about that disease in the context of the patient’s life • Terms such as “positive” or “negative” in referring to emotions not meant to imply judgment of the emotion per se • In any clinical context, physician or student–physician (and/or supervisor, or colleague) can make the discernment that experiencing and/or expressing a particular emotion – (1) does not advance patient-centered goals and/or - (2) is distressing for the patient, the physician, or both • This awareness should then trigger a process of working with or modulating the emotion to ensure that patient care (and physician well-being does not suffer The Example of Empathy • Does empathy even require feeling? Can we just keep it at the level of cognition? • Rhetoric of professionalism consistently urges learners toward empathy • In medicine, empathy has a positive valence • So why is it hard to achieve? • Underlying feelings of fear, dislike, vulnerability, judgment compromise empathy Do emotions matter in medicine? • Emotions influence both doctors and patients in critical areas such as – Decision-making – Information processing – Doctor-patient relationship • Patient emotions have a relationship to clinical outcomes (diabetes, MI) • Physician role models – Have trouble acknowledging their own emotions – Have trouble accurately identifying/responding to patient emotions Patients have emotions • Patient (negative) emotions are associated with – Increased clinical sxs (e.g., pain) – Decreased adherence to medical regimen – Decreased trust – Poorer follow-up – Poorer clinical outcomes – Poorer breaking bad news, addressing sensitive clinical issues • Students may perceive negative patient emotions as a barrier to care Medical students have emotions • Positive emotions – gratitude, happiness, pride. • Negative emotions - Anxiety, fear, vulnerability, guilt, sadness, anger, shame. • Aggression/dislike toward difficult patients. Students’ Fears • Big fear – will become detached from emotions picture scary monster • BIGGER fear – will become overwhelmed by emotions – Swept away – Self-protective – Picture bigger scary monster Physicians are (sometimes) terrible role models of emotions • physicians typically deal with anxiety by distancing themselves from their emotions • they rely on cognitive and behavioral strategies to help them respond to patients • Physicians tend to ignore negative emotions (sadness, anger) • Physicians not very good judges of reading their pt’s emotions; or acknowledging pts’ emotions – When do acknowledge, tend to offer only minimal empathy – Engage in “blocking behaviors” that discourage further emotional disclosure Detachment – Just how did this become the professional ideal? • “North American medical education favors an explicit commitment to traditional values of doctoring empathy, compassion, and altruism among them—and a tacit commitment to behaviors grounded in an ethic of detachment, self-interest, and objectivity.” – J. Coulehan, P. Williams • Scholars point out that clinical detachment was descriptive not prescriptive, based on sociological observations of dr/pt interactions – J. Halpern House M.D. • The epitome of the detached physician • When he relies on rationality, logic, analysis, he saves his patient • When he ventures into the emotional realm, it is invariably a catastrophe Written By : Johanna Shapiro, Ph.D. Source
