what doctors feel

How do emotions affect the practice of medicine? This is the complex theme behind the latest book by Dr. Danielle Ofri, What Doctors Feel, and the topic of this month’s ALiEM bookclub discussion.

Book Synopsis: What Doctors Feel

Through vivid reflections from the medical ward, Dr. Danielle Ofri, the author of What Doctors Feel, provides a window into the under-discussed emotional side of patient care. Eloquently weaved into these stories, Ofri also highlights the relevant literature on the subject, which is often just as powerful. Ofri points out that in western medicine there is a deeply routed belief that a dichotomy exists between reason and emotion. The experiences shared in this book challenge this theory by showing that physicians are highly influenced by their feelings. In fact, skills of empathy, compassion, and self-knowledge are a necessary component to being a good doctor.

Relevance to Medical Education

In medical education, we are fascinated by how students and residents best learn to be good physicians. According to Dr. Patrick Croskerry, there are three major skill sets in the “performance repertoire” of emergency physicians: procedural, affective, and cognitive. 1

More attention is often given to how medical students and residents perform on exams and their competence in procedural skill than to how learners acquire the proper cognitive skills and emotional intelligence necessary for patient care, communication, and the professional challenges in medicine.

Ofri argues that:

“the emotional layers in medicine, however, are far more nuanced and pervasive than we may like to believe. In fact, they can often be the dominant players in medical decision-making, handily overshadowing evidence-based medicine, clinical algorithms, quality–control measures, even medical experience. And this can occur without anyone’s conscious awareness.”

Of concern, academic research shows that medical students drastically decline in their empathy ability as they enter their clinical training during the third year of medical school. Ofri raises the point that it is in “this demoralized state that we send them into residency to accrue what are arguably the most influential and formative experiences of becoming a physician.”

In a recent ALiEM post, Dr. Javier Benitez reviews theories on how physicians develop expertise in clinical reasoning. We know that making the implicit process of complex decisions explicit is one method to teach clinical reasoning. What approaches could we use to teach affective skills?

In What Doctors Feel, Ofri provides examples of changes that are taking place in medical schools to better foster empathy, such as the Program for Humanism and Professional at the Robert Wood Johnson Medical School in New Jersey. In this program students and faculty meet together to discuss issues in patient care, burnout, and role modeling. Recently, Academic Medicine published a moving reflection from Sophia McKinley, a Harvard Medical School student participating in a Longitudinal Integrated Clerkship (LIC), where she speaks about the perspective she gained during her “patient centered learning” experience. 2 Should such programs continue to be exceptions in medical education, or should they be the norm?

Bookclub discussion questions

  1. How do emotions influence the way physicians interact with patients and make clinical decisions
  2. * Ofri opens this chapter (2) by pondering whether empathy is innate or learned. Do you think empathy is an inherent trait, learned, or a combination of both? Can empathy be taught, and if so, how?
  3. What barriers prevent physicians from empathizing effectively with their patients?
  4. * What does Ofri mean by “the hidden curriculum?”
  5. Are we adequately preparing physicians to cope with the emotional spectrum of caring for patients?  What are we already doing? How can we do better?

 *Questions adopted from Danielle Ofri’s website 

Bookclub Discussion

Acknowledgements

We would like to thank Dr. Danielle Ofri for providing suggested discussion topics and highly recommend visiting Dr. Ofri’s website for additional chapter discussion questions.

Disclaimer: Neither I nor this website have any affiliations, financial or otherwise, with the book or Amazon.com.

1.
Croskerry P. The cognitive imperative: thinking about how we think. Acad Emerg Med. 2000;7(11):1223-1231. [PubMed]
2.
McKinley S. The fifth white coat. Acad Med. 2014;89(3):420. [PubMed]
Jordana Haber, MD

Jordana Haber, MD

Director of Clinical Education
University Medical Center, Las Vegas