“An eloquent and honest take on the inner life of medical professionals. . . . Ofri’s passionate examination of her own fears and doubts alongside broader concerns within the medical field should be eye-opening for the public—and required reading for medical students.” —Publishers Weekly
“An invaluable guide for doctors and patients on how to ‘recognize and navigate the emotional subtexts’ of the doctor-patient relationship.” —Kirkus Reviews
What Doctors Feel:
How Emotions Affect the Practice of Medicine
Danielle Ofri, MD
On Sale Date: June 4th, 2013 (Beacon Press)
Disillusionment with the realities of being a doctor. Frustration because some patients cannot be helped. Resentment towards those who will not help themselves. There has been a steady stream of research into how doctors think, yet little attention has been focused on how they process emotions—and how those emotions affect the quality of medical care they provide.
Now, in What Doctors Feel: How Emotions Affect the Practice of Medicine, Dr. Danielle Ofri, whose three previous books have been praised by Jerome Groopman, Abraham Verghese, and Oliver Sacks, among others, sheds light on the how the complex emotional layers in medicine affect how doctors make decisions. “Doctors who are angry, nervous, jealous, burned out, terrified, or ashamed can usually still treat bronchitis or ankle sprains competently,” she writes. “The problems arise when clinical situations are convoluted, unyielding, or overlaid with unexpected complications, medical errors, or psychological components. This is where factors other than clinical competency come into play.”
Drawing on her two decades practicing medicine at New York’s Bellevue Hospital, as well as on interviews with other doctors and on scientific studies, Ofri brings alive the often dramatic realities of everyday patient care. She recalls her repulsion when, as a first year medical student and rape crisis volunteer in the emergency room, she faced a homeless woman who emitted a stomach-turning stench and had cockroaches crawling in and out of her clothing. While “gutlessly pretending to examine paperwork,” Ofri watches as a nurse’s aide, an older Haitian woman, talks soothingly to the patient, gently strokes her hair, and then puts an arm around her as she slowly leads her to the showers. “I sat hidden behind the desk, awed and humbled,” Ofri remembers. “I was experiencing a most visceral lesson in empathy. That aide’s act of compassion left me breathless.”
Weaving in stories of many other patients, including Mr. Carello, an opiate addict who is admitted to Bellevue for the fifty-seventh time for an overdose or withdrawal crisis, and Mr. Easton, a demented elderly man whose skeletal body is so badly ulcerated he seems hardly human, Ofri reveals a medical world that offers daily challenges to doctors’ empathy. Compassion can be hard to summon, she writes, when patients are hostile or manipulative, entitled or arrogant or have illnesses that appear to be self-induced, such as drug and alcohol addictions or morbid obesity. Culture, class, and language barriers, she explains, can also work against doctors staying in touch with their patients’ suffering. Asian patients she has worked with tend to keep up a stoic front, she notes, meaning doctors stop “seeing” their pain, while Hispanic patients are known for being very vocal about their symptoms, so doctors may quickly stop listening.
As important as empathy is in medicine, writes Ofri, it has been consistently observed that students lose empathy as they progress through medical school, particularly in the third year when they transition from the predictability of the classroom to the chaos of the hospital wards. Underscoring the “hidden curriculum of medical schools,” especially the empathy-sapping jokes, gallows humor, and slang used by harried interns and residents, Ofri explores why students lose empathy in their clinical years and looks at how some curriculums are changing so that students’ natural empathy can be maintained and nourished.
In the end, she argues, teaching empathy falls to supervising doctors. She notes with surprise that it was the older, white, male physicians she trained with at Bellevue who modeled empathy for her, treating every patient with old-school respect and curiosity about their lives. The widely revered Dr. Frank Spencer, she writes, would not hesitate to publicly dress down a resident, yet on rounds with students would swivel the bedside stool way down so that he was looking up at the patient. “Whenever you talk to a patient, you seat yourself at their level or lower,” Ofri remembers him instructing. “You never hover over them high and mighty. They are the ones who are sick, and they are running this interview, not you.”
Ofri illustrates the many other emotions that can profoundly affect patient care. She recalls being so panic-stricken during her first cardiac arrest code that her brain went completely and humiliatingly blank. “Fear is a primal emotion in medicine,” she writes. “The fear of making a mistake and causing harm never goes away, even with decades of experience.” She takes readers through the ongoing churn of stress, the constant thrum of anxiety, and the burning shame when a misdiagnosis puts a patient at risk. Through the story of her longtime patient, Julia, a young undocumented immigrant mother who is denied a heart transplant, Ofri also illuminates the sadness woven through the daily life of medicine. Tracing how doctors deal with, or more often bury, these emotions, she points to the ways patient care can be affected. If grief, for example, is relentlessly suppressed, she writes, the result is a numb physician who cannot invest in a new patient. If shame and guilt are so potent (along with the threat of lawsuits) that they prevent doctors from admitting medical error, patients are put at risk.
Ultimately, writes Ofri, the doctor-patient interaction is fundamentally a human one and emotions are the “basso continuo of this interaction.” For doctors, she argues, it is critical to be aware of the force of emotions in “rational” decision making. Patients, she notes, should be attuned to an interaction’s emotional subtext, which will help keep the focus on what is important. “Every patient deserves the best possible care that doctors can offer,” maintains Ofri. “Learning to recognize and navigate the emotional subtexts is a critical tool on both sides of the exam table.”
About the Author
Danielle Ofri, MD, PhD is an associate professor of medicine at New York University School of Medicine and has cared for patients at New York’s Bellevue Hospital for more than two decades. She is the author of Singular Intimacies: Becoming a Doctor at Bellevue, Incidental Findings: Lessons from My Patients in the Art of Medicine, and Medicine in Translation: Journeys with My Patients. Ofri is a regular contributor to the New York Times’ Well blog as well as the New York Times’ “Science Times” section and the New England Journal of Medicine. Her writings have appeared in Best American Essays and Best American Science Writing. She is the editor in chief of the Bellevue Literary Review. Ofri lives in New York City with her husband, three children, and their loyal lab mutt.
June 4th, 2013 **** $24.95, Cloth/978-0-8070-7332-2 ****$24.95, E-book/978-0-8070-7333-9