Sunday, December 5, 2010
The Emotional Demands of a Physician
In Chapter 5 the author writes, "I did not have the emotional reserve to witness and absorb the suffering of these children or to comfort their anguished parents. I had found my limits as a doctor." This really made me think of what a difficult position physicians are placed in. They went to medical school and began practicing to heal and save lives, but the very nature of their job demands that they take an emotional step back so that they are able to witness so much suffering and deal with death. We expect them to be caring and wholly invested in each patient, but in order for them to keep functioning day after day, they need to be at least slightly detached. I think most of us find some comfort in the dichotomy of life and death, but doctors don't get that luxury. As angry as I am to hear about cold or short physicians with poor bedside manner, this book has successfully elicited sympathy for their predicament, and I feel like I now understand that they make a lot of emotional sacrifices in order to witness such suffering every single day.
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Last spring my mentor worked at Children's hospital in St. Paul. I followed around various members of the staff while I was mentoring there and it was heart breaking. Everywhere you looked there was a sick child and upset parent but the staff seemed so indifferent to the emotions floating around. When we were on rounds one day we came to a child's bed that was 9 months old and currently going through withdrawal of his pain meds. His pacifier fell out of his mouth and he immediately started shaking and crying... the entire group of 14 people rounding paid no attention and continued discussing his case. A nurse finally came from the nurses station and put the pacifier back in his mouth. I was standing there shocked, I wanted to ask if anyone was going to comfort the child but felt it wasn't my place. I left that day feeling like I was going to cry but from that I learned you must have to detach yourself so that you can have a life outside of work.
ReplyDeleteYeah, I am not sure working with children would be my calling. I am sure that helping the neediest and those with the most life ahead of them is probably the most any of us could do, but I think eat would eat at me. Most of the patients I see are people transition to the later stage of life, and I still get sad when I find out someone moved into nursing home, or worse. I think a doctor would almost have to detach themselves, realize that this is a science, make decisions based on science, and live with statistical outcomes. I think it sounds cold and detached, but I am not sure we would have professionals in these areas if they became emotionally invested, at least not long.
ReplyDeleteI agree. At first the thought of a physician having to emotionally detach themselves was scary--I think most patients (myself included) want to believe that doctors are the most caring, concerned, empathetic individuals around. I think it is attractive to think that they want to care for you on an emotional level. I've always reacted very poorly when a physician was cold or seemed indifferent to my complaints, but now I understand that it is almost a necessity. Sure some physicians may be able to maintain a reassuring bedside manner, but deep down there has to be some emotional distance. After reading this book I really appreciate the emotional strain that physicians take upon themselves, and I think that I can be much more understanding when a doctor doesn't bend over backwards to imitate Patch Adams. I am certainly not condoning physicians being rude or short, but I can see how incredibly difficult it must be to maintain a basic level of concern for the patient without letting oneself become too emotionally invested.
ReplyDeleteI believe that physicians' emotional detach may be helpful in treating patients. We had a guest speaker in Addiction Medication this week who was caught because he went to the doctor to satisfy why he was missing work. His normal doctor was a friend and was on vacation. The replacement doctor ordered a urine analysis that showed the elevated level of acetaminophen. The recovering pharmacist said he ran into his normal physician after his treatment, and the physician said he would not have ordered the UA because they were friends and thought he was smart enough to stay away from prescription drugs. Can anyone else think of an instance where being buddies can negatively affect treatment?
ReplyDeleteAlthough this is not along the same lines as physician's having to distance themselves from sick children, I feel like pharmacists have to be able to distance themselves somewhat as well. There is only so much one can do to help people get the medications they need. Watching someone struggle to pay 10 dollars for their medications is also heartbreaking. Some patients have to do without, picking one medication over another. Even my CT struggles to pay for her many inhalers for COPD and takes Advair only once a day due to cost. The money issues drain me and are my least favorite part of pharmacy so far because I know that some patients are not getting the care they need.
ReplyDeleteI believe community pharmacists are very fortunate to have minimal contact to terminally ill patients, and was also a big reason I wanted to become a pharmacist. I knew I wanted to be in health care, but didn't think I could live a healthy and happy life working in a hospital surrounded by death. I've been working at the same pharmacy for 4 years now and a few of my local favorites have now passed away; I selfishly am glad that I was not in the position to tell them there is nothing left to do.
ReplyDeleteShelly, I agree with your comment about physicians emotionally detaching themselves. I have also felt upset when a physician wasn't friendly or curious about my concerns. I think that as pharmacists we must have a balance of emotion and detachment. Pharmacists in a community setting have a very unique role, in that patients don't have to make an appointment with us - they can just walk right up to the counter! Therefore, pharmacists are more approachable than physicians. I believe it is important to build a "therapeutic relationship" with our patients but we must also remain professional. There is an older pharmacist at my pharmacy who reads the obituaries every day and clips out our customer's obituaries and posts them at work. I usually don't recognize the names, but he has obviously developed an emotional attachment to the patients.
ReplyDeleteI can certainly understand what you mean when you say that doctors have to be somewhat detached. I just think of it in a different way. Part of being a doctor is to be able to put yourself in the patient’s shoes and truly understand what they are going through. And it’s the doctor’s responsibility to somehow find the strength and resolve to do the same thing with each new patient. This is the only way to avoid becoming desensitized to patient suffering because when that happens, there is no way that doctor can be as effective at treating patients. As we have read in “How Doctors Think”, even the best doctors miss critical diagnoses because they did not take the time consider all possibilities. Once a doctor starts to become detached from his patients, think how much harder it will be for him or her to stay 100% engaged with all patients- will it not be tempting to occasionally take the short cut especially when all the clues point to something obvious? Actually, I am glad I am not a doctor because I don’t think I could ever rest at night thinking of all the possibilities that I did not consider during the day. I am not saying it is an easy thing to do but doctors owe it to their profession and their patients to treat each patient individually and with their whole hearted attention.
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