Tuesday, January 22, 2019

Sonoma Medicine

The magazine of the Sonoma County Medical Association

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Hoping for More



Deborah Donlon, MD

What Doctors Feel: How Emotions Affect the Practice of Medicine, Danielle Ofri, MD, Beacon Press, 232 pages.

It seems the American public is yearning to figure out what makes doctors tick. First came How Doctors Think (2008) by Dr. Jerome Groopman, followed by What Doctors Feel (2013) by Dr. Danielle Ofri. According to Amazon.com, these two books are “frequently bought together.” They represent the yin and the yang of the physician psyche, one a guide to how our minds work, and the other a road map to our innermost feelings. From a patient’s perspective, there should be some powerful insights offered here. Based on the coordinating titles, one wonders if Drs. Groopman and Ofri got together over coffee one morning to decide who should publish first. His quote graces the cover of her book, endorsing it as the place “where science and the soul meet.”

Dr. Ofri has an MD and a PhD, and she completed a residency in internal medicine. She is the mother of three children, a working physician and writer, and an associate professor at New York University School of Medicine. Her inspiration for What Doctors Feel comes from patients she has cared for as a faculty member at NYU’s internal medicine residency at Bellevue Hospital. From her writing, it is clear that she has charged herself with teaching the psychosocial side of medicine to her students and residents. Rather than treating a patient with alcohol and drug withdrawal as just another admission, she probes to discover the exact moment in the past when the patient knew he was an addict, and she gets a moving response. Her underlings treat the patient with more concern and compassion as a result.

To a primary care physician in the trenches, Dr. Ofri’s book has enormous potential and appeal. How do we feel, anyway? Every 15 to 20 minutes, we walk into the next patient’s exam room. Each one has a chief complaint, or more likely, many complaints. It is our job to elicit information, show compassion, cure, heal, fix. And in family medicine, which many of us practice and teach in Sonoma County, there is always more than one patient in the room. The accompanying child, parent or partner also has a complaint, but not an appointment. How do we feel? Rushed, overwhelmed, concerned, altruistic, and often fortunate to be doing such challenging and beautiful work. Surely this book can offer us a road map for how to get in touch with our emotions, avoid burnout, remember the psychosocial perspective in caring for patients, and carry on.

What Doctors Feel is organized around a central figure: Julia, a young, undocumented mother with congestive heart failure who is hoping to receive a heart transplant. Dr. Ofri writes of the instant emotional attachment she feels between herself and Julia, based on their similarities in age, physical characteristics and stage of motherhood. Giving Julia her initial CHF diagnosis, which feels like a death sentence for someone without legal status, is so difficult that Dr. Ofri postpones it until the post-hospital follow-up visit. She uses every tool at her disposal to help Julia get a new heart, and she rides the emotional roller coaster with Julia from elation at the prospect of a transplant, to despair over an unanticipated complication.

While the story of Julia rings true in describing how close physicians can become with their patients, and the journey doctor and patient travel together, much of the book’s remaining pages disappoint. In those pages, Dr. Ofri details the rigors of residency training, and how some physicians respond to this constant stress and fatigue by making derogatory statements about the patients under their care, such as the doctor who says that an unwashed patient has “toxic sock syndrome.” Dr. Ofri writes about disillusionment, burnout, physician addiction, medical errors, and the unfortunate consequences of lawsuits on subsequent medical practice. All of these issues are relevant to practicing physicians, but one gets the sense that Dr. Ofri is trying to exorcize her own demons, atoning for her mistakes and near-misses, as well as promoting her other published works. There is not much new here; even Julia was the subject of Dr. Ofri’s previous publications. More research and fewer anecdotes would have made for a stronger book.

What Doctors Feel seems to be written more for the lay public than for a physician readership. There is a lot of detail about the process of medical school and residency training. We physicians remember those days like they were yesterday, and the memories are visceral. But residency, as intense and exhausting as it was, had a finite aspect that made it survivable. The practice of medicine over decades is something else entirely.

Here are four examples of what I hoped to get out of reading What Doctors Feel, but didn’t. First, when I see the name of my most challenging patient on my schedule for the day, or on a telephone message, I have an unpleasant internal reaction. However, I still need to provide the best care possible for this person and to put my feelings about them aside. Is this possible? Second, my clinic has just adopted a new patient portal, through which all my patients can contact me via email. What if a patient emails me with an urgent concern when I am not close to the computer? Also, do I wish to spend my leisure time, already limited, responding to emails from my patients? Third, there are work-hour restrictions for residents, but not for attending physicians. When one has been up all night working in the hospital, it is nearly impossible to show empathy to patients by the next afternoon. Fourth, our healthcare system has incentives in all the wrong places, leading to poor outcomes, poor care and poor morale among physicians. What will it take to turn this around?

I would like to read a version of What Doctors Feel written with a physician audience in mind. In the meantime, physicians can explore their emotional sides by participating in P&PD (personal and professional development) groups with their colleagues and a facilitator. Balint groups, which explore the doctor-patient relationship in a structured format, also encourage emotional growth and conflict resolution.

One of the highlights of Dr. Ofri’s book is the story of Dr. Herdley Paolini, a psychologist who created a program at a Florida hospital to combat physician disillusionment. Her program has been successful and multifaceted, and her message to the physician staff has been, “I’m available to accompany you on your journey.” Perhaps that sentiment captures what all of us would like to feel: that as physicians, we are not in this alone.

Dr. Donlon, a Santa Rosa family physician, serves on the SCMA Editorial Board.


Email: debbied@swhealthcenter.org


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