It is perfectly fine to be emotional in front of patients

Medicine offers you a front-row seat on life. Meaning is all around you. When you can see it, it gives you a sense of gratitude for the opportunity to do this work.
-Rachel Naomi Remen

The first-year medical student cried openly during the session. Not hard, but enough to be embarrassed.

“I’m really sorry,” she said, “but this is one of the things that scares me most about going into medicine. I cry all the time. When I get the least bit upset, the tears flow. I can’t help it. How can I be a doctor if I am crying all the time?”

She reached for a tissue and looked at me.

“What do you think?” I asked her. “Are you worried that you are too compassionate?”

“No, I don’t think so,” she decided, “but how can I take care of sick people like this?”

As a profession, we physicians are rarely accused of being overly empathetic despite the oaths we swear as we enter our careers (“May I see in all who suffer only the fellow human being…”). Even when we strive to be consistently caring, our execution often falls short, yielding to the pressures of our own lives and the need to get long lists of tasks accomplished. There is no shortage of real or imagined pressures that physicians blame for the loss of compassion just as there is no shortage of criticisms that patients fire back at physicians and at those of us who are helping to educate the next generation of doctors.

At its most fundamental level, is there a way to improve the doctor-patient relationship? An essay in the New York Times by chronicler of social innovation, David Bornstein, explores one approach that medical schools, including our own, utilize to help students fight the natural urge to become more-and-more emotionally detached from patients as they become physicians.

The Healer’s Art Course is an five-session elective offered during the first year of medical school that helps the students explore their own motivations, their fear of loss, and their experiences with grief. The course helps them understand that, beyond science, the practice of medicine still requires openness to mystery. The course also reminds them of their obligation to society and the world beyond.

The developer of the Healer’s Art Course, Dr. Rachel Naomi Remen, was an intern when a 3-year-old was brought into the emergency room after a car accident. The child died and young Dr. Remen accompanied one of the older doctors to tell the parents. Dr. Remen started to cry when the parents did. Later, the older doctor took her aside and berated her for being “highly unprofessional.” She didn’t cry again in the presence of patients or families for many years. Only later did she realize the damage that had been done when she was disciplined by the older doctor.

The Healer’s Art Course emphasizes “generous listening” among the participants. Hopefully, they take the skills they develop to the clinic and the hospital.

As one of the facilitators of Medical College of Wisconsin’s Healer’s Art Course, I was careful to let my weepy student tell her story and said that it was perfectly fine to be emotional in front of patients.

“It is one way we can share our stories together,” I said.

At the same time, I wondered if she might naturally gravitate toward a specialty where she would be spared emotional ups-and-downs.

I do not know if the Healer’s Art Course session impacted her, but she remained a good listener throughout medical school and is currently training to be an obstetrician/gynecologist. I can’t think of many other specialties where there is such potential for rapid fluctuations between heartbreak and delight.

I hope she continues to find meaning in her work during those moments of great happiness and those moments where the tears might start flowing once again.

Bruce Campbell is an otolaryngologist who blogs at Reflections in a Head Mirror.

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