As a doctor, I am very fortunate in that I do not have to give bad news that often( Baby is not ok, you have cancer, etc). When I do though, it hits me really hard. I find myself, depending on the patient reaction, fighting back my own tears when I see them upset and overwhelmed and wondering what to do. This is because I care so much about that patient that I would literally trade places with them if I could. I also find that when it comes to patient emotion, I am very easily projected upon. If the patient is taking the news badly, I am doing the same internally. If they are crying, I want to cry. If they are being “a trooper,” I find it that much easier to do the same. But, regardless of what I am feeling, I immediately do a mental and emotional pivot to convert my outer appearance to one of a comforting, calm, empathetic doctor without the emotional display. I guess there is a part of me that thinks it would be disrespectful to get too emotional or cry, like I am stealing their thunder or somehow making the situation about myself instead of concentrating on them. Of course, that is not what I would really be doing, I would be reacting because I care. I just don’t think patients would see it that way. I also think that at that moment, with that particular life-changing news, that patient needs someone strong to lead them through, not a blubbering mess. I think on some level, that they would possibly appreciate that I care so much, but that would get old quickly. Trust me though, I do blubber eventually, depending on what the news and the prognosis is. I just do not do it in front of the patient. This is why I could never be an oncologist. Just think about it. The majority of their job is to deliver bad news on a daily basis. There are those precious times when they get to celebrate a recovery or cure, but the bad seems to vastly outweigh the good. I just know myself. Burnout would come fast and furious as my emotions would overtake my clinical judgement. I admire those folks tremendously.
So, what is the role of emotion in medical practice? Are we really supposed to be outwardly cold and impassive and directly to the point in the case of bad news? Do patients really want us to save all the emotional display for themselves? Do they ever want to see our reaction? Do they even want to realize that we are human as well and are affected by the world around us? My guess, except for a handful of my patients, would be no. Most of my patients would tell you that they expect me to care, but they don’t necessarily want to “see it” because it would put them at risk for completely breaking down and not even hearing what I am trying to tell them. It’s like if I let my metaphorical wall down, my display of emotions alone would blast through the wall they are trying to put up to soak in the news that I am giving them.
A lot of patients have somewhat of a superhuman expectation of doctors. They do not expect them to ever be sick, have an emergency, miss a day of work, or show any emotion. I have been unfortunate enough to have had some serious illnesses in my past, causing me to miss extended periods of work, only to come back to find out that patients left my practice to go to another physician. Keep in mind that while I was gone, I had extensive coverage arrangements to satisfy all patient needs and that it was made clear that I was returning to my practice. But, it was still not enough. Patients got nervous, heard through some rumor mill that I was not coming back, figured that I had dropped the ball somehow and was going to let them down and left anyway. Situations like that get me thinking: Hey wait! I don’t drop them when they are gone or noncompliant for years and then want to come back! I give them a chance. Doesn’t that work both ways? Mind blowing news alert!: We are actually human! Just like our patients! Whaaat?! We have feelings, illnesses, life events, the whole nine yards. Sometimes I think it is more convenient for patients to view their physicians as something other than a human being. It’s a bit of a cop out really. It allows them to justify whatever unrealistic expectations that they have and use them to move on to another physician when they don’t get what they want. Now, let me be clear. I am not saying in any way, shape or form that it is somehow the patient’s responsibility to care about how i am doing or feeling on any given day. I just want them to realize, if only for a second, that doctors are people too. Have a fantastic day folks.
Dr. Katz
