How Doctors' Feelings Affect Their Patients' Care

Leigh Page

Disclosures

June 20, 2013

In This Article

Is Your Model of Physician Behavior Out of Date?

As a physician, you are a product of medical culture; in that culture, there are unspoken manners and mores that its members are expected to note and assimilate.

In dealing with patients, for example, the historical model has been for physicians to remain cool, calm, and collected at all times. Your approach is to be strictly scientific: logical, objective, methodical, precise, dispassionate, the very embodiment of the term "clinical." This, medical tradition has it, is in the best interest of doctors and patients alike.

That's been the model since Sir William Osler, the father of modern medicine and a paradigmatic figure for generations of doctors, called on his colleagues and students to demonstrate "imperturbability," which he defined as "coolness and presence of mind under all circumstances."[1]

"A rare and precious gift," Osler added, "is the art of detachment."

But today, an attitude of detachment is often a double-edged sword for physicians. In many ways, it can be useful and necessary. It insulates and protects you from the powerful emotions that patients display in your presence: anger, frustration, bewilderment, grief, rage. And it insulates patients from the roiling emotions that you may at times feel toward them.

However, a detached attitude also insulates you from empathizing with patients. A doctor/patient relationship may technically exist, but it's often too perfunctory to matter. The detached doctor talks in language that is over patients' heads, assumes that they understand what was said, and keeps her eye on the clock. That, research shows, can have a negative impact on clinical outcomes.

Is Detachment Necessary?

Physicians may justify this aloofness by framing it as necessary for efficient doctor/patient interaction, believing that with people in the doctor's personal life, there will be a different, more intimate standard of behavior -- one that is more empathic, outgoing, revealing, and vulnerable.

Unfortunately, it doesn't often work that way. Detachment is not like a light switch that you can turn on and off to suit the situation, experts maintain. It has a tendency to seep into all your relationships. It becomes a personal style of distancing yourself from the world -- not just from patients, but also from colleagues, family, friends, and even yourself.

The result can be unhealthy for physicians and patients alike.

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