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What Doctors Feel: How Emotions Affect the Practice of Medicine by [Danielle Ofri]

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Danielle Ofri

What Doctors Feel: How Emotions Affect the Practice of Medicine 1st Edition, Kindle Edition

by Danielle Ofri (Author) Format: Kindle Edition

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“A fascinating journey into the heart and mind of a physician” that explores doctor-patient relations, the flaws in our health care system, and how doctors’ emotions impact medical care (Boston Globe)

While much has been written about the minds and methods of the medical professionals who save our lives, precious little has been said about their emotions. Physicians are assumed to be objective, rational beings, easily able to detach as they guide patients and families through some of life’s most challenging moments. But understanding doctors’ emotional responses to the life-and-death dramas of everyday practice can make all the difference on giving and getting the best medical care.

Digging deep into the lives of doctors, Dr. Danielle Ofri examines the daunting range of emotions—shame, anger, empathy, frustration, hope, pride, occasionally despair, and sometimes even love—that permeate the contemporary doctor-patient connection. Drawing on scientific studies, including some surprising research, Dr. Ofri offers up an unflinching look at the impact of emotions on health care.

Dr. Ofri takes us into the swirling heart of patient care, telling stories of caregivers caught up and occasionally torn down by the whirlwind life of doctoring. She admits to the humiliation of an error that nearly killed one of her patients. She mourns when a beloved patient is denied a heart transplant. She tells the riveting stories of an intern traumatized when she is forced to let a newborn die in her arms, and of a doctor whose daily glass of wine to handle the frustrations of the ER escalates into a destructive addiction. Ofri also reveals that doctors cope through gallows humor, find hope in impossible situations, and surrender to ecstatic happiness when they triumph over illness.

ISBN-13

978-0807073322
Edition

1st
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On Kindle Scribe
Publisher

Beacon Press
Publication date

June 4, 2013
Language

English
File size

1204 KB
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Editorial Reviews

Review

“Taut, vivid prose . . . She writes for a lay audience with a practiced hand.”
—New York Times

“In her lucid and passionate explanations of the important role that emotions play in the practice of medicine and in healing and health, Danielle Ofri tells stories of great importance to both doctors and patients.”
—Perri Klass, author of Treatment Kind and Fair

“An invaluable guide for doctors and patients.”
—Kirkus Reviews

“Insightful and invigorating…makes the case that it’s better for patients if a physician’s emotional compass-needle points in a positive direction.”
—Booklist, starred review

“A fascinating journey into the heart and mind of a physician struggling to do the best for her patients while navigating an imperfect health care system.”
—Boston Globe

“Ofri gives voice and color to the heartbreak, stress, and joy that attends medical practice.”
—Library Journal

“A fabulous read.”
—Greater Good

“Essential reading in Medical HumanitiesShe weaves together personal anecdotes and medical learning in a compelling account of her medical decisions and reflections. Highly recommended.”
—Sara van den Berg, Professor of English, Saint Louis University

“Dr. Ofri's real-life experiences can be incorporated into a variety of health science curricula bringing course theory together with practical application. Readers gain critical insight into why applying theory in the practice of medicine requires empathy for the physicians.”
—Christine Whittrock, Department of Pharmaceutical Sciences, Temple University

“Part of medical education now is not only core competencies from a factual standpoint but also a social standpoint. Dr. Ofri has a way of communicating those lessons in a clear a cogent and very personal fashion.”
—Beth Dollinger M.D., Arnot Ogden Medical Center

“The perfect book for my teaching on the subject of lack of empathy in medical school students.”
—James Asa Shield, Jr., MD, Professor, Chairman, Department of Psychiatry, Virginia Commonwealth University

About the Author

Danielle Ofri, MD, PhD, is an associate professor of medicine at the New York University School of Medicine and has cared for patients at New York’s Bellevue Hospital for more than two decades. Ofri’s books and articles have become academic staples in medical schools, universities and residency programs. She is the editor in chief of the Bellevue Literary Review and writes regularly for the New York Times. --This text refers to the paperback edition.

Excerpt. © Reprinted by permission. All rights reserved.

Introduction

Why Doctors Act That Way

The experiences of medical training and the hospital world have been extensively documented in books, television, and film. Some of this has been probing and incisive, and some has been entertaining nonsense.

Much has been written about what doctors do and how they frame their thoughts. But the emotional side of medicine—the parts that are less rational, less amenable to systematic intervention—has not been examined as thoroughly, yet it may be at least as important.

The public remains both fascinated and anxious about the medical world—a world with which everyone must eventually interact. Within this fascination is a frustration that the health-care system does not function as ideally as people would like. Despite societal pressures, legislative reforms, and legal wrangling, doctors don’t always live up to these ideals. I hope to delve beneath the cerebral side of medicine to see what actually makes MDs tick.

One might reasonably say, I don’t give a damn how my doctor feels as long as she gets me better. In straightforward medical cases, this line ofthinking is probably valid. Doctors who are angry, nervous, jealous,burned out, terrified, or ashamed can usually still treat bronchitis orankle sprains competently.

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.

At this juncture in our society’s history, nearly every patient—at least those in the developed world—can have access to the same fund of medical knowledge that doctors work from. Anyone can search WebMD for basic information or PubMed for the latest research. Medical textbooks and journals are available online. The relevant issue— the one that has the practical impact on the patient—is how doctors use that knowledge.

There has been a steady stream of research into how doctors think. In his insightful and practically titled book How Doctors Think, Jerome Groopman explored the various styles and strategies that doctors use to guide diagnosis and treatment, pointing out the flaws and strengths along the way. He studied the cognitive processes that doctors use and observed that emotions can strongly influence these thought patterns, sometimes in ways that gravely damage our patients. “Most [medical] errors are mistakes in thinking,” Groopman writes. “And part of what causes these cognitive errors is our inner feelings, feelings we do not readily admit to and often don’t even recognize.”1

Research bears this out. Positive emotions tend to be associated with a more global view of a situation (“the forest”) and more flexibility in problem solving. Negative emotions tend to diminish the importance of the bigger picture in favor of the smaller details (“the trees”). In cognitive psychology studies, subjects with negative emotions are more prone to anchoring bias—that is, latching on to a single detail at the expense of others. Anchoring bias is a potent source of diagnostic error, causing doctors to stick with an initial impression and avoid considering conflicting data. Subjects with positive emotions are also prone to bias; they are more likely to succumb to attribution bias. In medicine, this is the tendency to attribute a disease to who the patient is (a drug user, say) rather than what the situation is (exposure to bacteria, for example).

This is not to say that positive emotions are better or worse than negative emotions—both are part of the normal human spectrum. But if you consider the range of cognitive territory that doctors traverse with their patients—genetic testing, ordinary screenings, invasive procedures, ICU monitoring, and end-of-life decisions—you can appreciate how the final outcomes can be strongly influenced by a doctor’s emotional state.

Neuroscientist Antonio Damasio describes emotions as the “continuous musical line of our minds, the unstoppable humming.”3 This basso continuo thrums along while doctors make a steady stream of conscious medical decisions. How this underlying bass line affects our actions as doctors—and the net effect on our patients (and on doctors when we ourselves become patients!)—is what intrigues me.

By now, even the most hard-core, old-school doctors recognize that emotions are present in medicine at every level, but typically this is lumped in with the catch-all of stress or fatigue, with the unspoken assumption that with enough self-discipline, physicians can corral and master these irritants.

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 evidenced-based medicine, clinical algorithms, quality control measures, even medical experience. And this can occur without anyone’s conscious awareness.

It could easily be argued that doctors are no more emotionally complex than accountants, plumbers, or the cable-repair guy, but the net result of doctors’ behavior—logical, emotional, irrational, or otherwise— can have life-and-death consequences for patients, which is to say, for all of us.

We all want excellent medical care for ourselves and our families, and we’d like to assume that the best care comes from the doctors with the best training, or the most experience, or the best U.S. News & World Report rating. However, the myriad effects of emotional underpinnings can confound all of these factors.

Despite this, the conventional stereotype that doctors are fairly emotionless continues to maintain its hold. Many trace this back to the eminent Canadian physician Sir William Osler, often considered the father of modern medicine for such revolutionary ideas as whisking medical students out of the staid classroom and bringing them to the bedside to learn medicine by examining actual patients. The current educational system of clinical clerkships and residency training is largely attributed to Osler, as are hundreds of snappy quotations. His continuing influence is apparent in the scores of diseases, endless libraries, and numerous medical buildings, hospital wings, societies, and awards that bear his name.

On May 1, 1889, Dr. Osler stood before the graduating medical class at the University of Pennsylvania and delivered a valedictory— and now canonical—speech entitled “Aequanimitas.”4 He stressed to these fledgling doctors that “a certain measure of insensibility is not only an advantage, but a positive necessity in the exercise of a calm judgment.”

While Osler may not have created these attitudes, he neatly encapsulated the general feeling about how doctors should behave.

Though he did warn against “hardening the human heart,” the stereotype of the detached, coolheaded physician springs from this idea of equanimity.

Popular culture has embodied this. Television doctors from Ben Casey to Gregory House are detached from their patients, lauded for their technological and diagnostic acumen. Even the selflessly idealist doctors (in Arrowsmith, Middlemarch, and Cutting for Stone) and the bitingly sarcastic doctors (in M*A*S*H, House of God, and Scrubs) maintain an equanimitous distance from their patients.

Every hospital dutifully includes the word compassion somewhere in its mission statement. Every medical school rhapsodizes about the ideals of caring. But the often unspoken (and sometimes spoken) message in the real-life trenches of medical training is that doctors shouldn’t get too emotionally involved with their patients. Emotions cloud judgment, students are told. Any component of a curriculum upon which interns slap the “touchy-feely” label is doomed in terms of attendance. Hyperefficient, technically savvy medical care is still prized over all else.

But no matter how it’s portrayed, and no matter how many high-tech tools enter the picture, the doctor-patient interaction is still primarily a human one. And when humans connect, emotions by necessity weave an underlying network. The most distant, aloof doctor is subject to the same flood of emotions as the most touchy-feely one. Emotions are in the air just as oxygen is. But how we doctors choose—or choose not—to notice and process these emotions varies greatly. And it is the patient at the other end of the relationship who is affected most by this variability.

This book is intended to shed light on the vast emotional vocabulary of medicine and how it affects the practice of medicine at all levels. Hopefully, the next time we find ourselves in a patient gown, we’ll better understand the workings of those who care for us. “Cognition and emotion are inseparable,” Groopman observes. “The two mix in every encounter with every patient.” In some scenarios, this mix is highly beneficial to patients. In others, it can be calamitous.

Understanding the positive and negative influence of emotions in the doctor-patient interaction is a crucial element in maximizing the quality of medical care. Every patient deserves the best possible care that doctors can offer. Learning to recognize and navigate the emotional subtexts is a critical tool on both sides of the exam table. --This text refers to the paperback edition.

From Booklist

*Starred Review* Tucked inside a white lab coat or scrub suit is a welter of human emotions that can play a large role in a doctor’s decision-making process. Ofri, an internist at New York’s Bellevue Hospital, explores the emotional core of doctoring. Suturing together her own experiences, the plights of memorable patients, and interviews with other physicians, she examines the diverse feelings—anger, grief, shame, disillusionment, gratitude, humility, joy—that can fluster or elevate physicians. “Fear is a primal emotion in medicine,” she writes, and doctors worry about making a mistake or even killing a patient. Sadness is an occupational hazard, and “A thread of sorrow weaves through the daily life of medicine.” Then there’s empathy. Is it innate, acquired, or both, and why do third-year medical students lose it? Ofri exposes her emotional side as she recounts the story of a longtime patient, an undocumented immigrant from Guatemala who finally receives a heart transplant but dies shortly after the procedure. Ofri admits, “Doctors who are angry, nervous, jealous, burned out, terrified, or ashamed can usually still treat bronchitis or ankle sprains competently.” Yet her insightful and invigorating book makes the case that it’s better for patients if a physician’s emotional compass-needle points in a positive direction. --Tony Miksanek --This text refers to an alternate kindle_edition edition.

Product details

ASIN ‏ : ‎ B008ED6AGS
Publisher ‏ : ‎ Beacon Press; 1st edition (June 4, 2013)
Publication date ‏ : ‎ June 4, 2013
Language ‏ : ‎ English
File size ‏ : ‎ 1204 KB
Text-to-Speech ‏ : ‎ Enabled
Screen Reader ‏ : ‎ Supported
Enhanced typesetting ‏ : ‎ Enabled
X-Ray ‏ : ‎ Not Enabled
Word Wise ‏ : ‎ Enabled
Sticky notes ‏ : ‎ On Kindle Scribe
Print length ‏ : ‎ 233 pages

Best Sellers Rank: #544,860 in Kindle Store (See Top 100 in Kindle Store)
- #32 in Physicians
- #304 in Doctor-Patient Relations
- #474 in Biographies of Medical Professionals (Kindle Store)

Customer Reviews:
373 ratings

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Danielle Ofri

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Danielle Ofri is a doctor at Bellevue Hospital in New York City. She is one of the foremost voices in the medical world today, shining an unflinching light on the realities of healthcare and speaking passionately about the doctor-patient relationship. Her newest book is "When We Do Harm: A Doctor Confronts Medical Error."

Ofri is a regular contributor to the New York Times and is also the editor-in-chief of the Bellevue Literary Review. She lives in New York City and is determined to get through the Bach cello suites before she kicks the bucket.

Here's her TED talk on Deconstructing Perfection: https://youtu.be/CaSv741Gjlg

And her TED talk on Fear, A Necessary Emotion: https://youtu.be/yToDJlfa_Tc

She's also performed at The Moth: https://youtu.be/9h5lkiizC7M

All of Danielle Ofri's articles and events can be found at: www.danielleofri.com

You can get her monthly(ish) newsletter: https://danielleofri.com/subscribe/

Twitter: @danielleofri

Facebook: DanielleOfriMD

Instagram: danielle_ofri

(Photo Credits: Joon Park and John Abbot)

Customer reviews

4.6 out of 5

373 global ratings

5 star		74%
4 star		16%
3 star		5%
2 star		4%
1 star		1%

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Top reviews from the United States

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Vince

A Must-Read

Reviewed in the United States 🇺🇸 on January 11, 2023

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Loved this book. It is an impactful and well-written account of the wonderful, harrowing and everything-in-between emotions experienced by physicians practicing medicine. A must-read for anyone in, or aspiring to be in, the medical field.

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BBMa

Must read for Med students

Reviewed in the United States 🇺🇸 on October 23, 2022

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Great insights and good reads for junior doctors or trainees

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Dr. Awen I. Rowan-Nelson

A book that you must read!

Reviewed in the United States 🇺🇸 on May 26, 2014

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Danielle Ofri's book, What Doctors Feel, is one that should be required reading in all medical schools, and it should also be read by all patients to help them better navigate the undercurrents of their relationships and experiences with their doctors, particularly, as these undercurrents involve the generally unspoken emotions and fears of, and the risks to, their physicians.

As both a long-time patient with extremely complex medical conditions, and someone who has always been fascinated by medicine (I read medical textbooks for fun as a teenager), I thought that my knowledge of the world of doctors and medicine was more than adequate. Yet, after reading Ofri's book, one physician's apology to me, and another's visceral reaction to the suggestion by another physician that he perform a surgery on me that might be medically necessary, but that would, inevitably, leave me disabled to some degree, took on entirely different shadings and nuances, and I learned a great deal that I would never have otherwise known.

Yet, do not get the idea that this book is dry, or aimed at teaching some sort of lesson, or written to either apologize for or explain away the negative behaviors of physicians. Quite the opposite on all counts. The book is engaging, enlightening, compelling, and brilliantly written. What might indeed have been dry material in other hands is, quite literally, a page-turner in Ofri's. I read the book cover-to-cover in two sittings. As readers, we learn about how the doctors in the book feel through their encounters with patients, some whom they have grown to love, and through the tortuous and exacting training that medical students endure in order to become physicians. And, we too, grow to love some of the patients, and to empathize with both the doctors and their patients, and we care about their stories as much as we do about the stories of our favorite fictitious characters. Yet, every person and every story in this book is real--each was lived by fellow human beings, and we come to care deeply about every one of them.

Both my husband and I are professors, and we both plan to use the book in our classes. While he is a classicist, who will use the book in a class about illness and injury, praise and blame, I am a philosopher, and I will use the book in a writing class about confronting moral dilemma. We choose our books carefully, always with an eye to picking texts that our students will love to read, and this book is one that we will use for years, I am quite sure.

I give this book my highest recommendation.

19 people found this helpful

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MpDakkak

Must-Read for Medical Students

Reviewed in the United States 🇺🇸 on July 3, 2013

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I needed this book. After finishing a surgery clerkship, I was at the lowest place I had been all year. A friend told me at the beginning of the rotation to keep a copy of my personal statement in my pocket, because at times, I would forget why I had chosen to enter medicine. I didn't take his advice, but recognize now that I did become that detached and disillusioned. Thankfully, the combination of a family medicine rotation and having this book to read when patients "would rather not see a medical student" has served the same purpose - if anything, I understand better than ever why I am doing this.

I chose to pursue medicine after realizing that I needed more emotional attachment to the people, and the cause, that I wanted to work for. We talk a lot about `hidden curriculum' in medical school, but I'd take it a step further and say your book discusses the `neglected curriculum' of medical school. I'm almost done with my first year on the wards now, and am familiar enough with patient care to identify with all the `feelings' assigned as chapter titles. Countless times, I've wondered how residents and attendings deal with difficult patient deaths, the joy of successful treatment, medical errors, the reprimanding that takes place during M&M, litigation, etc. All we have to learn from are the behaviors our supervisors respond to these situations with, and so much is left unspoken on account of being `resilient.'

I can't thank Dr. Ofri enough for her willingness to be vulnerable and brutally honest. I greatly appreciated the work she did to present different perspectives on each emotion, with many of the stories not having classic `happy endings.' An appeal of medicine is to work in an environment that challenges you at your emotional, ethical, and philosophical core, as much as it does intellectually. But while so much time is spent developing our intellect amidst emotional challenges, you're essentially left on your own to process experiences and develop coping skills. While there are attempts to create a space for reflection in a `doctoring' course, discussions among peers are limited in value compared to hearing from the professionals we aspire to become. This book provides invaluable insight to students.

31 people found this helpful

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Top reviews from other countries

Nikkib

Interesting read

Reviewed in the United Kingdom 🇬🇧 on January 16, 2017

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I admit I didn't read every word, the title intrigued me and I found it interesting to read about how certain cases have affected, and effected Doctors in the medical profession. What I did find myself doing was flicking back and forth through the book if a case study took my interest and I read more about the Doctor and how their emotions were affected, and ultimately how it made them a better Doctor in most cases.
1 case runs through the book which shows the full range of emotions a Doctor goes through; other case studies show how important their job is in finding out every fact so they can best treat the patient; and what goes wrong when the Doctor becomes the Patient.

One person found this helpful

J. Parry

Doctors are people too!

Reviewed in the United Kingdom 🇬🇧 on January 25, 2017

Verified Purchase

The doctor is just the doctor, right? Just the one we go to when we are sick or worried about our health, who we expect to do something to make us better.

But this very well written and searching insight takes us right into their world, the stresses they have to endure, the exhaustion, self-doubt and triumphs, the joys and griefs, the endless paperwork, the fear of being sued if someone thinks they haven't done their job properly.

Sometimes inner walls of self-protection go up. A doctor who comes over as harsh and uncaring may simply have gone into survival mode, his natural empathy frozen as disillusionment and exhaustion sets in. Others care too much and break down in grief at losing a patient they had built a deep bond with.

There are also the fascinating cases, the detective work to find out what exactly is wrong with a patient, the triumphs, and often the laughter, as the doctor interacts with the huge spectrum of patients (who happen to be people too), and sometimes bizarre situations

You get it all with this book.

And what I got from this book, more than anything else, was more empathy with the face behind the desk.

2 people found this helpful

Ciara O'Mahony

Astounding book

Reviewed in the United Kingdom 🇬🇧 on August 1, 2021

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I read “What Doctors Feel” in one sitting. The way Dr Ofri describes her experiences with her patients and the emotions behind those experiences is incredibly heart - felt, and I imagine, very cathartic to many.

Julia’s story had me gripped from beginning to end. What a beautiful way to describe doctors experiences with grief. I am so grateful to Dr Ofri for writing this book and sharing her experiences as a doctor. It has instilled renewed faith about the profession and helped me to understand the challenges that physicians get faced with everyday.

Highly recommended!

One person found this helpful

Mandy P

As advertised

Reviewed in the United Kingdom 🇬🇧 on July 24, 2019

Verified Purchase

As advertised

gabriele roden

A profound and most sensitive account of the rewards and ...

Reviewed in the United Kingdom 🇬🇧 on August 27, 2017

Verified Purchase

A profound and most sensitive account of the rewards and the limits of being a physician. A rainbow of real experiences clarify the full spectrum of the responsibilities and human frailties that connect both physician and patient in their journey to understand and heal.
Gabriele Roden MD

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