Beacon Broadside

What Doctors Feel: How Emotions Affect the Practice of Medicine

A look at the emotional side of medicine–the shame, fear, anger, anxiety, empathy, and even love that affect patient care 

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 doctors' emotional responses to the life-and-death dramas of everyday practice have a profound impact on medical care. And 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. In What Doctors Feel, Dr. Danielle Ofri has taken on the task of dissecting the hidden emotional responses of doctors, and how these directly influence patients. 

How do the stresses of medical life-from paperwork to grueling hours to lawsuits to facing death-affect the medical care that doctors can offer their patients? Digging deep into the lives of doctors, 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. Danielle Ofri offers up an unflinching look at the impact of emotions on health care.

With her renowned eye for dramatic detail, 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 and her forever fear of making another. 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. But doctors don't only feel fear, grief, and frustration. Ofri also reveals that doctors tell bad jokes about "toxic sock syndrome," cope through gallows humor, find hope in impossible situations, and surrender to ecstatic happiness when they triumph over illness. The stories here reveal the undeniable truth that emotions have a distinct effect on how doctors care for their patients. For both clinicians and patients, understanding what doctors feel can make all the difference in giving and getting the best medical care. 

About the Author

Danielle Ofri, MD, PhD is an associate professor of medicine at New York University School of Medicine and has cared for patients at Bellevue Hospital for over two decades. She is the author of Singular Intimacies: Becoming a Doctor at Bellevue, Incidental Findings: Lessons from my Patients in the Art of Medicine, and Medicine in Translation: Journeys With My Patients. Ofri is a regular contributor to the New York Times' Well blog as well as the New York Times' "Science Times" section.

Follow @DanielleOfri on Twitter. Like her on Facebook. Visit her website.

 

Read the Boston Globe review of What Doctors Feel:

Ofri adroitly balances presentation of her own experiences and those of others, with research into the emotional aspects of medical practice. The result is 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 that often seems to value “efficiency,” measured in dollars and minutes, more than the emotional well-being of either physician or patient. 

Read Danielle Ofri on the "The Darkest Year of Medical School" at Slate:

Students are not just learning medicine during the third year of medical school; they are learning how to be doctors. Despite the carefully crafted official medical curriculum, it is the “hidden curriculum” that drives the take-home messages. The students astutely note how their superiors comport themselves, how they interact with patients, how they treat other staff members. The students are keen observers of how their supervisors dress—and how they may dress down those around them. They figure out which groups of patients can be the object of sarcasm or humor, and which cannot.

On a daily basis, the students witness fear, anger, grief, humiliation—in patients and doctors alike—all of which are largely unacknowledged. They see egos rubbing up against each other, hierarchies at play, bureaucracies in action. They observe that many of the niceties of patient care fall prey to the demands of efficiency and high patient turnover. Much of what they learned about doctor-patient communication, bedside manner, and empathy turns out to be mere lip service when it comes to the actualities of patient care.

Read "My Near Miss" by Danielle Ofri at the New York Times:

I never told anyone about my lapse — not my intern, not my attending physician, certainly not the patient’s family. I tried to rationalize it: the radiologist had caught the bleeding, and no additional harm had come to the patient.

But what if I had discharged the patient? What if I had started her on a medication like aspirin that could have worsened the bleeding? My error could easily have led to a fatal outcome. The patient was simply lucky.

 

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

One of the NYTimes most emailed stories this week is from Danielle Ofri, MD:

I never told anyone about my lapse — not my intern, not my attending physician, certainly not the patient’s family. I tried to rationalize it: the radiologist had caught the bleeding, and no additional harm had come to the patient.

But what if I had discharged the patient? What if I had started her on a medication like aspirin that could have worsened the bleeding? My error could easily have led to a fatal outcome. The patient was simply lucky.

In hospital lingo, this was a “near miss.” But a near miss is still an error, just one in which backup systems, oversight or sheer luck prevent harm. [Read the rest here]

 

 

Defiant Brides: The Untold Story of Two Revolutionary-Era Women and the Radical Men They Married by Nancy Rubin Stuart

C-SPAN2’s Book TV aired Nancy Rubin Stuart’s reading at the Fraunces Tavern in New York.

Barnes & Nobles’s book blog spoke with Nancy Rubin Stuart about the book and its jacket art:

“As I completed research and began writing the manuscript, I realized that there were several historical images of the treacherous Peggy Shippen Arnold but only one of Lucy Knox. Worst of all it was only a silhouette! Initially I thought the cover might depict the faces of those two women combined with several historical images of the American Revolution. Ruefully I mentioned my disappointment about the lack of portrait for Lucy Flucker Knox to my editor, Gayatri Patnaik, at Beacon Press, who assured me that we’d find a different solution. Bob Kosturko, the designer who created a stunning cover for The Muse of the Revolution, she explained, would be creating the cover for Defiant Brides.

“Gayatri was right. Some months later, Beacon Press sent me a draft of Bob’s cover design. I was thrilled. He had cleverly used the bottom half of a lavish portrait of Peggy Shippen Arnold but had eliminated her face. Simultaneously that solved the problem of Lucy’s missing face and hinted at the unpredictable course of the marriages that both teenagers embarked upon in the first flush of passion during the turbulence of the birth of the United States.” [Read the rest here]

 

Light Without Fire: The Making of America's First Muslim College by Scott Korb

Rollo Romig's wrote about the book and Zaytuna College on The New Yorker's book blog:

In his new book, “Light Without Fire,” the religion writer Scott Korb followed Zaytuna’s inaugural class of fifteen students through their first year, and his reporting reveals one of the most intriguing recent American experiments in providing a religious education. [Read the rest here]

 

Brokers of Deceit: How the U.S. Has Undermined Peace in the Middle East by Rashid Khalidi

Daily Beast write-up by Peter Beinart of "Open Zion”:

Here Khalidi is not faulting the Israelis; they are a sovereign state acting in what they determine is their best interest, even if one views it as unjust, immoral, and at the expense of legitimate Palestinian rights. More importantly, Israel is only able to act with such impunity because they understand the power of the “no light” dogma. The U.S. accepts the perpetual “existential crisis” of Israel that makes the occupier the victim and gives them a free pass to act as they wish.

 

White Coat, Black Hat: Adventures on the Dark Side of Medicine by Carl Elliott

On CNN.com's Opinion Page, Carl Elliott examines how misdeeds are covered up in medical bureaucracies:

The problem is in how success is measured, which is not in the soft currency of ethics or trust, but in how much money the strategy saves for the institution. If it pays for everyone to keep quiet, that's what the bureaucrats will advise. [Read the rest here]

 

Mr. Hornaday’s War: How a Peculiar Victorian Zookeeper Waged a Lonely Crusade for Wildlife That Changed the World by Stefan Bechtel

Review of Mr. Hornaday's War in the Idaho Statesman

In "Mr. Hornaday's War: How a Peculiar Victorian Zookeeper Waged a Lonely Crusade for Wildlife that Changed the World," author Stefan Bechtel introduces us to a character seemingly filled with contradiction. Hornaday is fearless in his life's pursuits but overcome with fear at the rapid destruction of animal populations. He is a trophy hunter who travels to the far reaches of unsettled lands in Africa and India to take down a Bengal tiger or a wildebeest but carries guilt for the taking of 22 buffalo during his hunt out West. He is an avid hunter who is vehemently opposed to the new rapid-fire shotgun of his time because of its ability to strike so deftly. He is perpetually at odds with nearly every leader of his day but develops a unique kinship with Teddy Roosevelt that lasts a lifetime. [Read the rest here]

 

My Mother’s Wars by Lillian Faderman

The Gay & Lesbian Review full-page review in the May/June issue. Calling the book “a remarkable work of reconstruction” and noting its “voluminous list of resources,” the review concludes, “As usual, Faderman’s seemingly effortless prose is the result of years of patient research. As far as possible, she has made sure that the past will be accurately remembered.”

 

Dirt Work: An Education in the Woods by Christine Byl

Women’s Adventure Magazine online review: “While Byl does not romanticize nature or her work, she skillfully uses poetic language, daring the reader to feel the grit, grim, and sore muscles of working ten hour shifts digging, chopping, clearing, and creating trails…Dirt Work is highly recommended for readers who love the outdoors, and especially those who have hiked in a national park or forest, and benefited from the hard work of trail crews.”

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Intensive Care: A Doctor's Journey

New York Times WellBlog regular contributor Danielle Ofri has been praised for turning the triumphs and trials of medicine into riveting and compassionate stories. This eBook exclusive edition offers 98 pages of her best work for $3.99. 

Buy it from: 
Amazon | Barnes & Noble | iTunes Bookstore | Kobo | Google Books

This eBook original exhibits Danielle Ofri's range and skill as a storyteller as well as her empathy and astuteness as a doctor. Her vivid prose brings the reader into bustling hospitals, tense exam rooms, and Ofri's own life, giving an up-close look at the fast-paced, life-and-death drama of becoming a doctor. She tells of a young man uncertain of his future who comes into the clinic with a stomach complaint but for whom Dr. Ofri sees that the most useful "treatment" she can offer him is SAT tutoring. She writes of a desperate struggle to communicate with a critically ill patient who only speaks Mandarin, of a doctor whose experience in the NICU leaves her paralyzed with PTSD, and of her own struggles with the fear of making fatal errors, the dangers of overconfidence, and the impossible attempts to balance the empathy necessary for good care with the distance necessary for self-preservation. Through these stories of her patients, colleagues, and her own experiences, Intensive Care offers poignant insight into the medical world, and into the hearts and minds of doctors and their patients. These stories are drawn from the author’s previous books and one is from her forthcoming book, What Doctors Feel: How Emotions Affect the Practice of Medicine.

Praise for Danielle Ofri

“The world of patient and doctor exists in a special sacred space. Danielle Ofri brings us into that place where science and the soul meet. Her vivid and moving prose enriches the mind and turns the heart. We are privileged to journey with her from her days as a student to her emergence as a physician working among those most in need.” —Jerome Groopman, author of How Doctors Think

“A gifted storyteller … Ofri describes how her patients’ histories stirred her to practice medicine more compassionately, inspired her with their hope and fortitude.” —Sarah Halzack, The Washington Post

“Danielle Ofri is a finely gifted writer, a born storyteller as well as a born physician, and through these … brilliantly written episodes covering the years from studenthood to the end of her medical residency, we get not only a deep sense of the high drama of life and death that must face anyone working in a great hospital but a feeling for the making of a physician's mind and soul, and for her bravery and vulnerabilities as she goes through the long years of apprenticeship.” —Oliver Sacks, MD, author of Awakenings and The Man Who Mistook His Wife for a Hat

“Danielle Ofri stands observing at the crossroads of the remarkable lives that intersect at Bellevue. She is dogged, perceptive, unafraid, and willing to probe her own motives, as well as those of others. This is what it takes for a good physician to arrive at the truth, and these same qualities make her an essayist of the first order.” —Abraham Verghese, author of The Tennis Partner and My Own Country

“Dr. Ofri is an exemplary model of professional compassion. Her beautiful stories linger at the curtains of disease, of class and culture of life, and of inevitable death. The stories challenge us to create new narratives of caring and listening.” —Bruce Hirsch, Tikkun

“Danielle Ofri has so much to say about the remarkable intimacies between doctor and patient, about the bonds and the barriers, and above all about how doctors come to understand their powers and their limitations.” —Perri Klass, MD, author of A Not Entirely Benign Procedure and The Mercy Rule

“Her writing tumbles forth with color and emotion. She demonstrates an ear for dialogue, a humility about the limits of her medical training, and an extraordinary capacity to be touched by human suffering. . . . an important addition to the literary canon of medicine.” —Jan Gardner, The Boston Globe

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Americans by Choice

Danielle Ofri is a writer and practicing internist at New York City’s Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients. You can follow Danielle on Twitter and Facebook, or visit her homepage.

Read more about Beacon’s immigration titles at “Beyond SB1070” on Beacon.org

The first thing I always do on July 4th is unfold my New York Times to where the Declaration of Independence is printed on the back page, as it is every year. I’m a fairly jaded New Yorker, but seeing the original writing every year always makes my heart skip a beat. And now that I have three young children, I’m even more thrilled to show off this documentary evidence of what it means to be American. Plus, I get to impress them with how I still remember the first paragraph by heart from my junior high school days.

This year, when I flipped through the newspaper, something else caught my eye. A full-page ad from the Carnegie Corporation declared, “Immigrants, the Pride of America.” Centered among 46 photos of immigrants with impressive resumes was a picture of the venerable American capitalist with the following text below:

“Andrew Carnegie, who founded Carnegie Corporation of New York in 1911, was an immigrant from Scotland. We at Carnegie Corporation salute his legacy, along with the contributions of the millions of other immigrants who have made, and continue to make, our nation strong and vibrant. We are committed to helping immigrants become integrated into the civic fabric of our nation because enlightened citizenship is the everlasting strength of our democracy. Our national motto, E pluribus unum— “out of many, one” — continues to be an ideal we can all aspire to and a true guiding light for our nation.”

I’m not normally swayed by such unabashed patriotism, but after the steady stream of vitriol in the immigration debate, this was a welcome relief.

Link Roundup: Online Conversation Starters

Beacon authors have been collecting laurels lately for their powerful writing and progressive ideas. Here's a sampling from this past week:

The May edition of the Internet Review of Books finds Tucson journalist Margaret Regan's The Death of Josseline to offer "A Desperately Needed Message."

Dr. Danielle Ofri, author of Medicine In Translation, has a stunning "Cases" piece in the Science section of the New York Times.

Finally, a wave of praise for Amie Klempnauer Miller's She Looks Just Like You on the The StrollerDerby blog, which quotes Salon.com's "delightful" interview with the author, plus over on Mombian. Also, ForeWord Reviews in their May/June issue, says: "She Looks Just Like You tells a story that parents from all sorts of 'categories' need to hear." And the June issue of Curve Magazine notes, "Motherhood can be scary for anyone, but when it comes to lesbian, Nonbiological moms-to-be, there was no real guidebook—until now. Miller talks about the excitements and difficulties that come from being the lesbian partner who doesn't give birth."

Department of Congratulations

Kudos to nonprofit publisher Bellevue Literary Press, an independent press run out of New York University's School of Medicine, for Paul Harding's Pulitzer Prize winning novel Tinkers. Boston-area independent bookstore Brookline Booksmith adds to the applause for Harding, a local author, and Galleycat re-airs its interview with Danielle Ofri, editor-in-chief of the Bellevue Literary Review.

Danielle Ofri: Doctor-Writers: What Are the Ethics?

Danielle Ofri is a writer and practicing internist at New York City’s Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients (View the YouTube book trailer.) You can follow Danielle on Twitter and Facebook, or visit her homepage.

There is a veritable epidemic of doctor-writers out there. What is going on?

Are doctors suddenly in the kiss-and-tell mode? What about confidentiality? Professionalism? HIPAA?

As one of the aforementioned doctor-writers, I look upon this trend with both awe and trepidation.  I suspect that that this flourishing literary phenomenon relates to the public’s fascination and fear about all things medical. It also relates to the falling away of previous, pedestal-like images of doctors and doctoring. Lastly, it may have occurred to the medical profession-- and this has taken a few centuries, it seems-- that doctors have profound emotional reactions to the work we do, and that exploring these reactions may offer benefit to both patient and doctor.

Whatever the reason, this literary genre appears to be here to stay, and it is worth considering the ethical implications. Legally, there doesn't appear to be much beyond protecting identity and avoiding libel.

Danielle Ofri: In Praise of Public Hospitals

Today's post is from Danielle Ofri, a writer and practicing internist at New York City's Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients. You can follow Danielle on Twitter and Facebook, or visit her homepage. This post originally appeared on her Medicine in Translation blog at Psychology Today.

HOLIDAY DISCOUNT FOR BEACON BROADSIDE READERS
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Public hospitals have a bad rap. They're viewed by many as hospitals of last resort, and most patients with private insurance do anything to avoid them.

As a long-time physician in a public hospital, I'm sensitive to this reputation. I wouldn't work in my hospital if I didn't feel that it delivered excellent health care. I'm certainly aware that private hospitals have amenities that public hospitals can't afford, but many of these are cosmetic issues.

On the cosmetic side, though, public hospitals have come a long way. Bellevue Hospital, where I work, has built a gorgeous ambulatory care building, complete with a soaring atrium that floods the waiting areas with sun and space. The ICUs and emergency wards have been renovated to enviable standards.

But beyond cosmetics, there is an extremely dedicated staff who is committed to providing high-quality care, despite the many financial and logistic challenges that public hospitals face.