Sunday, May 27, 2012

Should Doctors Feel?

There was an article in today's New York Times called "When Doctors Grieve."  Leeat Granik mentions her mother's long battle with cancer and the family's relationship with her oncologist.  She is now a health psychologist and has just published an study done by interviewing 20 Canadian oncologists.  While I know nothing about the methodology she discusses, I found her conclusions, as she summarized them for the NYTimes, to be thought provoking:

We found that oncologists struggled to manage their feelings of grief with the detachment they felt was necessary to do their job. More than half of our participants reported feelings of failure, self-doubt, sadness and powerlessness as part of their grief experience, and a third talked about feelings of guilt, loss of sleep and crying.
Our study indicated that grief in the medical context is considered shameful and unprofessional. Even though participants wrestled with feelings of grief, they hid them from others because showing emotion was considered a sign of weakness. In fact, many remarked that our interview was the first time they had been asked these questions or spoken about these emotions at all.
The impact of all this unacknowledged grief was exactly what we don’t want our doctors to experience: inattentiveness, impatience, irritability, emotional exhaustion and burnout.
Even more distressing, half our participants reported that their discomfort with their grief over patient loss could affect their treatment decisions with subsequent patients — leading them, for instance, to provide more aggressive chemotherapy, to put a patient in a clinical trial, or to recommend further surgery when palliative care might be a better option. One oncologist in our study remarked: “I see an inability sometimes to stop treatment when treatment should be stopped. When treatment’s futile, when it’s clearly futile.”

I wondered if  one or two (or a few) psychotherapy sessions might help doctors who deal with death or other difficult patient issues?  Might brief psychotherapy give these doctors a chance to  express and explore difficult emotions in way that might make them more comfortable with their feelings --even social or culturally unacceptable feelings-- and be more aware of how these feelings are impacting their work?  It's just a moment of wonder.  I don't want this to be read as a wish to medicalize normal emotions or to suggest that all oncologists need long-term psychotherapy, or that such a thing even be required, it's  just a question of 'what if' such a venue were easily available in a non-stigmatizing environment?  What do you think?  Maybe it's just the sort of thing one should feel comfortable talking with colleagues, or a nice spouse, about, though I think the point of the article was that it isn't okay to talk about these things without being seen as weak or troubled.