Have you left a doctor's office feeling frustrated because you simply can't seem to find a connection? Why do some doctors seem so rude and emotionless? I will never forget a particularly unsettling incident in the operating room while I was a young and impressionable medical student on my first surgery rotation: Attending Surgeon: "Intern, what’s the story on this patient?” Resident Intern (replies sheepishly): "This patient is a 51 year old with a left breast lump, and 17 out of 20 lymph nodes positive for cancer, returning to the operating room.” Attending Surgeon (in a very matter-of-fact tone): “Oh, she’s F_ _ _’d.” It felt as though the room temperature fell below zero for a moment—not because the OR is preserved like a freezer, but because the surgeon’s response seemed so cold. The intern fought hard not to appear uncomfortable in light of that deadened, crude response. But because medical school and residency have constructed a strict hierarchy, not unlike the military, there was no way that this intern was going to speak up in return—despite having a parent that also suffered from breast cancer. At the time, being so low on the totem pole, I found myself peering over the sterile field in the corner and thinking: A. I’m so glad surgery is not my field of interest (sorry, surgeons, but some of you can be pretty uninviting). B. How in the world do physicians reach this surprising level of stoicism? Last week, I discussed how challenging it can be to say goodbye to patients, despite this unnerving feeling that we as physicians are not supposed to allow ourselves to feel for them. Why is that? Why do we seemingly model our behavior after vampires? And how can we effectively treat patients if we don’t display compassion? Primary care doctors are stereotypically more of the warm and fuzzy kind (relatively speaking), although I have met some very down-to-earth and compassionate specialists. However, there is still an underlying, unspoken culture among physicians across all specialties, including primary care, which frowns upon the expression of emotions in the medical field. In some circles of health professionals, showing emotion is simply a big no-no. As a patient, you may be curious about how this trend of stoicism evolved. When were physicians first taught of this unspoken ideology, which encouraged them not to feel? I can recall as far back as my Gross Anatomy class while in medical school. In the early stages of the course, I was part of a small group of 3-4 eager medical students forced to confront our first real deceased human. There was no denying how real he initially felt to us. He had a tattoo on his arm of someone's name, and it was clear he cared for that person. He had numerous surgical scars, more than we could count. Who was this man? How did he come to leave this world? Who did he leave behind? My peers and I contemplated the answers to these mysterious questions, even though we'd never discover their answers, while respectfully dissecting our mysterious cadaver. When the course initially began, the medical school required its students to attend a “support group” of sorts. They understood the potentially emotional transition that may occur for us students as we likely faced death for the first time in the flesh. I remember the support group instructor seeking our candor as he asked, “How are you all emotionally dealing with dissecting a cadaver?” I was relieved to hear this question. And asking it was appropriate and very professional on the faculty’s part, a way of addressing our internal struggles head-on. I have always been grateful for my education at Drexel University, and this is one of the numerous reasons why. In my conversations with other medical students, a few did reveal their emotional struggles (whether it was spiritual, religious, or personal) with encountering a corpse face to face. However, when the instructor asked for our personal perspectives, I was surprised to find that no one voiced their thoughts, their unsettling feelings about working with cadavers for the first time. My classmates were afraid to discuss their emotions in an atmosphere where “sharing your feelings” is typcially discouraged, despite how much our instructor prodded. How can you blame them? Finally, there was one student who spoke up, and whose words I will never forget. He said that he sought to view the cadaver as an “object,” so that he could complete the dissection tasks But it was only when he viewed the cadaver’s hands that this person became "real" to him. “You do a lot with your hands,” I remember him saying. He, too, was struggling to resist those emotions. Then, there is that one patient who feels like a thousand patient encounters, who really makes your heart sink. There eventually came a point when the shock of confronting a deceased human evaporated for us, and we finally got down to work. We felt grateful and respectful towards this kind soul who sacrificed his body for our education. There was a sense of peace and calmness to the entire process. Now, as a ripe physician able to reflect on my journey, I have finally understood the complex reasons behind the detached doctor phenomenon: it’s a coping mechanism. Sometimes, it’s necessary for physicians to build a concrete wall to guard their emotions. Otherwise, it would be challenging to function through our day-to-day lives as healers. Because, truly, after seeing a sick patient after sick patient, if you allow yourself to feel too much, it can significantly wear you down and render you dysfunctional. Imagine experiencing these intimate, defining moments every single day: doctors see an average of 20 patients, several of whom are either very ill or possibly dying. A couple more suffer from major depression, and possibly even contemplating suicide. Another one or two are infuriated with you for caring enough about them to deny the very drugs that are driving their addiction. Several others may be frustratingly non-adherent to their treatment, and their health is deteriorating irreversibly as a result. Then, there is that one patient who feels like a thousand patient encounters, who really makes your heart sink because frankly, he or she is one of the nicest people you have ever met, and there is something very serious going on with their health ... and it's truly unfair. Hopefully this provides some perspective as to why some physicians may appear to be stoic or cold, even rude, on the outside. I do believe that some very talented and socially-adept physicians learn to balance compassion with emotional detachment, which should always be our goal. But for the rest, it’s simply about learning to cope, a survival of the fittest. Because, how else can we function in our day-to-day lives? How else can we go home and leave it all behind? Side note: deep down ... we don't. We think about, and sometimes even excessively ruminate, over the tragedies we encounter as physicians. We just don’t admit it. Source
As mentioned above "it's a coping mechanism". Therefore physicians AND SURGEONS should take regular sessions on how to communicate with patients properly, and how to show empathy.
