30 July 2013

Are Your Doctor's Feelings Getting In the Way?

Sir William Osler, the founder of modern medicine has been the topic of more blogs and articles the last few weeks. I think I have figured out why. It is because of the principles he taught are coming under attack and some are not overly happy about this. This Medscape article credits Osler with, “The historical model that has been for physicians to remain cool, calm, and collected at all times. Your approach is to be strictly scientific: logical, objective, methodical, precise, dispassionate, the very embodiment of the term "clinical." This, medical tradition has it, is in the best interest of doctors and patients alike.”

In medicine today, patients are not as kind with this type of an attitude by their doctor and want to the doctor to be able to empathize with them and honestly answer questions rather than avoiding the question or answering only part of the question. In other words, this attitude of detachment can be a double-edged sword. While this will insulate and protect you from the powerful emotions displayed by patients, and protects patients from your emotions, is this a good thing?

A detached attitude can insulate the doctor and prevent the doctor from empathizing with patients. A doctor/patient relationship may technically exist, but that is the extent of it. The doctor will talk in a language that is over the patients' heads, but mistakenly assumes that the patients understand what is said and keeps the doctor on schedule. Research now shows that this often has a negative impact on clinical outcomes and the patients are most unhappy.

This doctor detachment is not a switch that can be turned on and off when desired. The detachment seeps into their relationships and then the physicians become detached from the world around and even from themselves. This is unhealthy for physicians and patients alike. Then the pent up feelings may lead to burnout. Cardiologist, Seth Bilazarian, MD, defines burnout as a physical or mental collapse caused by overwork or stress.

What also hurts and makes it difficult for doctors to express emotion is the pedestal many patients have put them on. It is unfortunate that the medical culture grooms doctors to assume that role. Is it any surprise that some doctors view themselves as special and above others? But it's lonely at the top, and when a doctor falls, such as when a serious medical error is made, it's a long way down. It's made longer by the fact that many doctors choose to suffer in silence.

While many physicians believe in the myth of perfection, they don't deal well with errors and find it difficult to put these errors into words. When doctors realize that they are part of a larger picture and imperfect or human like the rest of us, the doctor/patient relationship will improve, medicine will become more meaningful for both parties, and doctors will find that they can communicate more on the level of the patient without the fear of breaking the pedestal.

When doctors rehumanize themselves, medicine will gain, humanity will be helped, and patients will want to become more involved in improving their own health. Everyone will then gain.

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