Emotions in medicine -- shove them or show them?

​​Recently, I responded to a series of colleague’s tweets regarding the way an intern was treated. https://twitter.com/CadenceDO/status/823300940895842311  The intern was part of a team that cared for a young adult in the ICU, and they had to withdraw life support. (I know nothing of the situation, but withdrawing life support generally occurs when brain activity is not present.) So, one of the most gut-wrenching events to experience not only for the family members, of course, but also for the medical personnel caring for the patient.
 
The tweet story went on to explain that once care had finished, the intern asked to step away for a few moments in private and collect himself. (Or herself. Interesting side question: would this story play differently if the intern were male or female?) The intern was then given a negative evaluation comment by the attending physician because the intern displayed emotions.
 
Because there are times when when I get drained and need to recover, this story generated a ton of thoughts and concerns.
 
#1) Are there instructors out there teaching our medical students/residents to “not feel”? Let me be clear: if medical professionals lose their humanity, then health care is no better than being treated by a robot. Quite frankly, I don’t want to be treated by people who have zero emotional response if I live or die. And also, I don’t want to BE a treating physician who has no emotional response to my patients’ situations.
 
#2) Let’s talk burnout. There is a direct correlation with suppressing emotional distress/stress and the development of burnout. There are papers upon papers written on this subject. People have developed freakin’ CURRICULUM about how to “talk through” these stressful times with peers, family, or counselors. Training a doctor to suppress the very thing that makes them human? Cruel. Destructive.

 
#3) Have I broken down in front of patients? Yes. A little bit. I’ve teared up, choked up, and got the tight chest before. It’s happened when someone is telling me something awful. It’s happened when I’ve had to tell a patient something horrible. And you bet I’ve stepped away to collect myself. I’ve sat in a quiet room and sobbed for a few minutes. After work, I’ve needed to take a long drive to clear my head. There are key people I talk to, when things build up inside.
 
#4) But doctors have to stay professional, right? Yes. That is a true statement. It’s a fine line. But basically, if I go to pieces, then no, I’m not able to care for my patients. So yes, there must be a degree of separation. A degree. Not total separation. Is it hard? You bet it is. Necessary? Yes. Does that mean I don’t feel as deeply? No way. What this intern did to manage his emotional response to a painful situation was completely appropriate. The attending physician completely missed the opportunity to teach, nurture, guide, and build upon this event. 180 degrees missed the point. So badly missed that I’m confident that it hurt the intern and anyone else who is subject to this type of training.
 
 
I have years of trying to learn how to manage the emotions on the job. With that having been said, situations always come up where that response occurs and we need to manage it.
 
Let me share my example. I was on call recently. The ER doctor called me. A mid-career colleague’s wife had unexpectedly died and they were in the ER. So I went to the hospital. Not for a patient, but to support my colleague. (He recently moved here, and has no family in this area.) Another colleague joined us, and there we all three sat, in the family room. Three physicians. One in misery, and two hurting in empathy. We chatted. He cried. The other supporting colleague and I teared up. After several long hours, I had to leave him to continue my call duties. Numb. (Nothing compared to my colleague who lost his wife.) But I still needed to function and help people.
 
The next day, after two intense hospice discussions with patients and families, I was drained. Then, that evening, I saw the name of one of my Ob patients pop up on the hospital list. I dropped by the ER. My patient was having a miscarriage. I had a choice to make: let the ER doctor tell her or I can go talk with my patient. The right answer was obvious. I waded through the thick emotions in her patient room and broke the very bad news to the patient and her husband. They cried. I teared up, but tried to stay present and available to help, either by answering questions or empathizing.
 
So at the end of a series of those days, you bet I’m drained. If I couldn’t step away when needed? I’d be useless for all of the other duties during that time. And I’d burn out. To a crisp.
 
But if I didn’t feel pain along with my colleague and patient? Then I’d be useless as a physician.
 
I’ve been lucky that along the way, a few attending physicians and colleagues have taught me how to step away and how to balance emotions and duties.
 
This intern? His attending physician taught the exact wrong lesson. The attending taught what NOT to do. Hopefully someone will mitigate the damage done. Because learning to suppress humanity will fry the average physician and any healthcare professional to an emotional crisp within a few short years. If we are going to succeed as professionals and as humans, we have to help ourselves so we can help others.