In a recent issue of JAMA, Dr. Michael Stillman writes about the emotional pain of delivering bad news to a patient he has known through the best and worst of times.
Earlier in my career, delivering bad news seemed like a technical challenge. I would methodically seat patients and their family members facing one another, pause for a moment after reporting that there was an “unexpected finding” on a scan, and search for an opportunity to say that I “wish things were different” and that I would be there to help until the very end. This routine, though slightly stiff, helped anchor me in whatever emotional swell was to come.
Now, however, these conversations just make me sad. …
Patients suffer and die, and a physician must find the balance being feeling her own humanity and maintaining the professional stance that allows her to move on. There are no simple guidelines, although Dr. Stillman suggests remembering the good times his patients have had and focusing on those moments.
Emotional hazards of practicing medicine
I wonder just how aware patients are of the psychological burden of being a doctor. Dr. Stillman writes:
I love practicing medicine. Unequivocally. Yet it sometimes seems as much a burden as a privilege. We begin our careers in the anatomy room, a ghoulish lab in which many “civilians” would faint. We cut our teeth in bloody operating rooms and intensive care units from which few people leave intact. We spend our lives bearing witness to the sufferings and diseases of troubled souls. We are well paid, intellectually stimulated, and, if we are lucky, trusted and maybe even loved by our patients. Yet on certain days, when our patients do not do well, the trade-off seems untenable.
How are we to protect ourselves from the emotional hazards of the practice of medicine? How are we to stand with our patients through the very worst while avoiding depression, significant stress reactions, and even substance abuse or addiction? …
There is simply no way to be a good but distant physician.
Stress, burnout, depression, and suicide are all very real possibilities for physicians. (See Reluctant patients: The mental health of doctors.) Patients might do well to remember this from time to time and communicate their appreciation. And physicians would do well to share their stories with each other, so that they might not feel so alone with the burden of keeping patients alive and well.
Image: Dr. Malpani’s Blog
Michael D. Stillman, Melancholy, The Journal of the American Medical Association, April 6, 2011, vol 305 no. 13, pp. 1277-1278
TE Quill, RM Arnold, F Platt, “I Wish Things Were Different”: Expressing Wishes in Response to Loss, Futility, and Unrealistic Hopes, Annals of Internal Medicine, 2001, vol 135(7), pp 551-555