The doctor’s emotional switch


The “doctor switch,” a protective coping mechanism ingrained into the emotional training of doctors, is a double-edged sword.

Doctors see and experience things that many people would consider intimate, gory, horrifying and even repulsive on a regular basis. Doctors must balance the scales of life and death in their hands in addition to the heavy responsibility of carrying the health and wellness of their patients in addition to living their own personal lives. The “doctor switch” is what I call the emotional state doctors often learn to acquire in order to prevent themselves from feeling vulnerable to all of these daily emotional assaults on their mental health. This emotional stoicism could also be described as compartmentalization, a thick skin, putting up walls or even, frankly, dehumanization. Regardless of what it’s called, many believe its role is to prevent doctors from getting more burnt out and depressed.

As I notice less human interaction with the modernization of patient care, physicians must cautiously welcome the benefits of these changes and be cognizant of the tendency many seem to have to lose the coveted skill once known as bedside manner. In the metacognition of how doctors think, efficiency and outcomes often trump the patient-doctor relationship. Good bedside manner — a term that could be used to summarize empathy, humanism, and genuineness — has been associated with better patient satisfaction, adherence to medicines, and even less physician burnout and depression.

However, we are left wondering why research shows that physician trainees are losing their ability to connect with patients as they go through the process of becoming a doctor and acquiring this thick skin. This paradox of gaining experience yet becoming number to it, I believe, is in part due to this doctor switch.

From the patient’s perspective, it is imperative that one is able to trust the doctor with the intimate information one is disclosing. With maximal vulnerability and exposure, trust and empathy must be mutual. It is easy to get caught up in the job and forget that your patient perceives you as a human being with the privilege of taking care of them.

As health care modernizes with technology and digital communications more integrated into our care of patients, we as physicians should resist the temptation to close our emotional doors and embrace the ups and downs that come with the privilege of patient care. After all, are we treating disease and prescribing medications or are we treating mothers, sons, grandparents, sisters and friends?

Mark P. Abrams is a cardiology fellow.

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