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Physician, heal thy emotional self

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In 2007 U.S. doctor and author Jerome Groopman caused a minor stir with his book How Doctors Think, in which he suggested that "most (medical) errors are mistakes in thinking," but added, "part of what causes these cognitive errors is (doctors') inner feelings, feelings that (they) do not readily admit to and often don't even recognize."

As an explicit complement to Groopman's book, enter What Doctors Feel, by prolific writer and New York internist Danielle Ofri.

Like Atul Gawande, another East Coast physician-writer, Ofri's previous work has explored the often-inhospitable territory in which physicians find themselves, both during and after their training.

Again like Gawande, she tends to berate the process of medical education even as she has suggested -- implicitly, and perhaps reluctantly -- that the ardours of training and the sacrifices demanded of trainees ultimately are worth it, to the extent that they yield compassionate but tough physicians.

This time out, echoing Groopman, Ofri writes that "most doctors are not aware of the underlying emotions that are influencing their behaviour."

Via a series of clinical vignettes, she suggests that medical training ought to foster feeling at least as much as thinking. While it is important to have memorized and regurgitated clinical algorithms, she suggests, and notwithstanding resistance on the part of curriculum planners and students alike to "touchy-feely stuff... learning to recognize and navigate... emotional subtexts is a critical tool."

It is sadly not news that "many doctors... live with the festering burn of dissatisfaction," and that this will "ultimately be felt by patients."

What is interesting, however, is Ofri's suggestion that what doctors feel, percolating below a surface resplendent with the multiple "goods" that come with our status, is a pervasive sense of inadequacy, and that from this arises an unidentified but often debilitating sense of shame.

"Given," she writes, "that physicians are always striving for and expecting perfection, every doctor feels that he or she falls short to some degree. Perhaps shame and self-blame are built into the system because of an unrealistic and pervasive expectation of perfection." (One shudders here, aware of a sign in a local hospital urging all toward "perfect care.")

This is a powerful, if not completely novel, indictment, and there will be many who read Ofri with frustration and disdain. Although she writes well, with passion and personality, given the context it is frustrating to see her conflate and confuse feeling and thinking, blurring as many do the distinction between them. Nevertheless, she asks difficult and important questions.

"Does the system designed to train doctors have to be an empathy-sapping experience?" Or could trainees, "steeped in a medical culture in which knowledge (is) equated with power," be encouraged to realize that empowering knowledge must necessarily include knowledge of self, and that a physician's awareness of his or her limitations, far from being detrimental to patient care, may actually foster better care, care imbued with an understanding of "the distinction between curing and healing, (which doctors don't get), but patients instinctively do."

In mid-summer, our hospitals are flush with freshly minted doctors, trying to swim rather than sink as the ink dries on their diplomas. Inasmuch as "teaching empathy (and other 'soft' skills)... falls not to course directors... but to the supervising doctors who oversee... trainees on the wards," Ofri has set a challenge.

We have moved some way toward banishing shame from our collective societal bedrooms. Ofri's little book urges those of us privileged to care for patients and educate physicians to attenuate its stain in the sickroom.

Ted St. Godard is a Winnipeg physician.

Republished from the Winnipeg Free Press print edition August 3, 2013 A1

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Updated on Saturday, August 3, 2013 at 6:35 PM CDT: Fixes formatting.

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