Heal thy emo­tional self

Winnipeg Free Press - Section G - - LIFE -

IN 2007 U.S. doc­tor and author Jerome Groop­man caused a mi­nor stir with his book How Doc­tors Think, in which he sug­gested that “most (med­i­cal) er­rors are mis­takes in think­ing,” but added, “part of what causes th­ese cog­ni­tive er­rors is (doc­tors’) in­ner feel­ings, feel­ings that (they) do not read­ily ad­mit to and of­ten don’t even rec­og­nize.”

As an ex­plicit com­ple­ment to Groop­man’s book, en­ter What Doc­tors Feel, by pro­lific writer and New York in­ternist Danielle Ofri.

Like Atul Gawande, an­other East Coast physi­cian-writer, Ofri’s pre­vi­ous work has ex­plored the of­ten­in­hos­pitable ter­ri­tory in which physi­cians find them­selves, both dur­ing and af­ter their train­ing.

Again like Gawande, she tends to be­rate the process of med­i­cal ed­u­ca­tion even as she has sug­gested — im­plic­itly, and per­haps re­luc­tantly — that the ar­dours of train­ing and the sac­ri­fices de­manded of trainees ul­ti­mately are worth it, to the ex­tent that they yield com­pas­sion­ate but tough physi­cians.

This time out, echo­ing Groop­man, Ofri writes that “most doc­tors are not aware of the un­der­ly­ing emo­tions that are in­flu­enc­ing their be­hav­iour.”

Via a se­ries of clin­i­cal vi­gnettes, she sug­gests that med­i­cal train­ing ought to foster feel­ing at least as much as think­ing. While it is im­por­tant to have mem­o­rized and re­gur­gi­tated clin­i­cal al­go­rithms, she sug­gests, and not­with­stand­ing re­sis­tance on the part of cur­ricu­lum plan­ners and stu­dents alike to “touchy-feely stuff... learn­ing to rec­og­nize and nav­i­gate... emo­tional sub­texts is a crit­i­cal tool.”

It is sadly not news that “many doc­tors… live with the fes­ter­ing burn of dis­sat­is­fac­tion,” and that this will “ul­ti­mately be felt by pa­tients.”

What is in­ter­est­ing, how­ever, is Ofri’s sug­ges­tion that what doc­tors feel, per­co­lat­ing be­low a sur­face re­splen­dent with the mul­ti­ple “goods” that come with our sta­tus, is a per­va­sive sense of in­ad­e­quacy, and that from this arises an uniden­ti­fied but of­ten de­bil­i­tat­ing sense of shame.

“Given,” she writes, “that physi­cians are al­ways striv­ing for and ex­pect­ing perfection, ev­ery doc­tor feels that he or she falls short to some de­gree. Per­haps shame and self-blame are built into the sys­tem be­cause of an un­re­al­is­tic and per­va­sive ex­pec­ta­tion of perfection.” (One shud­ders here, aware of a sign in a lo­cal hos­pi­tal urg­ing all to­ward “per­fect care.”)

This is a pow­er­ful, if not com­pletely novel, in­dict­ment, and there will be many who read Ofri with frus­tra­tion and dis­dain. Al­though she writes well, with pas­sion and per­son­al­ity, given the con­text it is frus­trat­ing to see her con­flate and con­fuse feel­ing and think­ing, blur­ring as many do the dis­tinc­tion be­tween them. Nev­er­the­less, she asks dif­fi­cult and im­por­tant ques­tions.

“Does the sys­tem de­signed to train doc­tors have to be an em­pa­thy-sap­ping ex­pe­ri­ence?” Or could trainees, “steeped in a med­i­cal cul­ture in which knowl­edge (is) equated with power,” be en­cour­aged to re­al­ize that em­pow­er­ing knowl­edge must nec­es­sar­ily in­clude knowl­edge of self, and that a physi­cian’s aware­ness of his or her lim­i­ta­tions, far from be­ing detri­men­tal to pa­tient care, may ac­tu­ally foster bet­ter care, care im­bued with an un­der­stand­ing of “the dis­tinc­tion be­tween cur­ing and heal­ing, (which doc­tors don’t get), but pa­tients in­stinc­tively do.”

In mid-sum­mer, our hos­pi­tals are flush with freshly minted doc­tors, try­ing to swim rather than sink as the ink dries on their diplo­mas. Inas­much as “teach­ing em­pa­thy (and other ‘soft’ skills)… falls not to course di­rec­tors… but to the su­per­vis­ing doc­tors who over­see… trainees on the wards,” Ofri has set a chal­lenge.

We have moved some way to­ward ban­ish­ing shame from our col­lec­tive so­ci­etal bed­rooms. Ofri’s lit­tle book urges those of us priv­i­leged to care for pa­tients and ed­u­cate physi­cians to at­ten­u­ate its stain in the sick­room.


Ofri asks dif­fi­cult and im­por­tant ques­tions.

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