Empathy & Emotional Distance – Thoughts on Danielle Ofri’s “What Doctors Feel”

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“The profound sadness of dying babies, mourning parents, vegetative children is impossible to ignore. Yet the culture of medicine doesn’t offer much space to explore this.”

Danielle Ofri examines the lack of attention given to doctors’ emotions in her newest book, “What Doctors Feel.” Through careful retelling of both her own stories, and the stories of others, Ofri invites us to evaluate the role of feelings in the patient/clinician relationship, and what happens when doctors aren’t given the space to acknowledge and process those feelings. She writes, “It could easily be argued that doctors are no more emotionally complex than accountants, plumbers, or the cable-repair guy, but the net result of doctors’ behavior—logical, emotional, irrational, or otherwise—can have life-and-death consequences for patients, which is to say, for all of us.”

Her work asks us to consider where empathy belongs in patient care, and on a larger scale, how we actually define empathy. Ofri proposes “to have compassion—literally, as its Latin roots suggest, to be able to suffer with—one must have empathy. It is impossible to fake compassion; empathy is a necessary prerequisite.” She goes on to simplify: “It’s the ability to see and feel from another person’s perspective.” It seems intuitive in healthcare, yet multiple studies have shown that empathy decreases the further along one is in their medical career—and doctors lose the capacity to consider their patients’ perspective.

“The truth is that most students enter medical school with strong humanistic and empathic tendencies.”

So, at what point do clinicians lose their ability to empathize? The Boston Globe published an article in March reporting that empathy scores fall between the time students started medical school and graduation, with the most significant drop occurring in the third year, when med students start caring for their first patients. A doctor at Boston University School of Medicine suggests students believe they have to create distance from patients to protect themselves. “It is time-consuming and physically draining to be involved in a very emotional situation.’’

By creating that distance and compartmentalizing grief, doctors put themselves at risk for misjudgment, “[s]ome doctors reported that after a death that felt to them like a “failure,” they would treat the next few patients overaggressively. Conversely, if doctors had witnessed what seemed like unnecessary suffering, they would pull back with the next few patients, leaning away from aggressive treatment, even when it might have been warranted.” Denial or disregard for doctors’ feelings can also ultimately lead to burnout.

DanielleOfri

So why now, with more information available to us, are we seeing this emotional distancing? Ofri looks at doctors trained decades ago: “What these older physicians exhibited is termed clinical curiosity. They strove to understand their patients in order to elucidate the underlying medical conditions. This thoroughness, patience, and dogged curiosity may have been ingrained in them because they trained at a time when there were no rapid CTs or MRIs. But even now, when these diagnostic tools are at their fingertips, these physicians maintain this approach to patients, one that serves to appreciate the dignity and uniqueness of each patient and his or her illness.”

We’re left to consider a question: Does an emotional connection with patients lead to better medical treatment? And if so, how can doctors simultaneously care for themselves as they process what Ofri has recognized as the “profound sadness” that can come along with making that connection?

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Aubrie-Ann Jones is a student in the Master’s Program in Narrative Medicine at Columbia University. She holds an MFA in Fiction from The New School, and a BA in Anthropology from Fordham University. Aubrie is hoping to promote Narrative Medicine training in both medical schools and in the clinical environment after graduation, and to continue to explore the patient/clinician relationship, particularly in trauma care. She is a writer, traveler, advocate, teacher, and runner who is currently heading up Operations and Leadership & Development at a boutique executive search firm that builds teams for NYC-based tech startups. Twitter: @aaj1026