The five most prevalent emotions felt by residents and medical students in this study were gratitude, anxiety, happiness, sadness, and anger. Compassion, guilt, pride, relief, and depression rounded out the top ten. A patient's tragedy was the only experience to trigger both positive and negative emotions in the forms of compassion and sadness.
"The consistency of anxiety and guilt among all participants triggered by uncertainty, powerlessness, and perceived responsibility for untoward outcomes was really striking," said Deborah Kasman, M.D., assistant professor of internal medicine at Georgetown and principal investigator. "While learning can be enhanced by some degree of anxiety, there is a definite harmful tipping point when that anxiety gets in the way of delivering quality care and can contribute to burnout and illness in the doctors' themselves."
Using inpatient pediatric and internal medicine rotations as a backdrop, ten medical trainees agreed to participate in a series of observations, self-reporting into Dictaphones, and lengthy interviews conducted by researchers over the course of a week. The goal was to document and explain experiences that "moved them" or that they "took pause with," in an attempt to map out the fullest range of positive and negative feelings they had and what events caused them.
Many doctors expressed a high level of anxiety when uncertain about dealing with a patient's needs. First year resident Sam said, "I always panic initially when I get called to do something new and I don't know what the heck is going on with the kid or how to treat whatever the problem is."
When dealing with guilt over a poor patient outcome, first year resident Jane said, "The patient just stroked out, and it was a big stroke. I was devastated…I thought it was my fault…I ran into his family who were all completely cheerful and supportive, [saying] 'Oh thank you so much for taking care of him' and I'm feeling like, 'Oh, I killed him.'"
Almost all participants expressed happiness when they forged a connection with their patients or when patients improved. Participants also expressed for the opportunity to learn and become a physician. With the exception of two students who used humor as a coping mechanism, the majority of participants expressed sadness when patients' conditions worsened or when they experienced tragedy.
Doctors' enhanced ability to express their own emotions has proven benefits for patient and doctor. Previous studies cited by Dr. Kasman in her paper have shown that doctors can avoid burnout and negativity by effectively expressing their feelings about work. Another study showed a direct correlation between physicians who can capably manage their emotions and a decreased rate of cancer, coronary artery disease, and suppression of their immune system.
"When we are training people to handle life and death decisions, to learn to listen to and empathize with their patients, we've got to pay close attention to the doctors feelings too," said Kasman. "There is no way to improve medical education, and for that matter patient care, unless we observe what events evoke these complex emotions doctors feel as they learn to embrace the profession and offer them help in managing this tidal wave of competing feelings."
Dr. Kasman recently accepted dual appointments at Georgetown University Medical Center in the department of internal medicine and the Center for Clinical Bioethics. She conducted this research while serving as an ambulatory care Health Science and Research fellow at the U.S. Veterans Affairs Puget Sound Health Care System in Seattle, Washington. The research was funded by The U.S. Veteran's Administration. The research was conducted with Kelly Fryer-Edwards, Ph.D., and Clarence H. Braddock, III, M.D., Ph.D., both of University of Washington School of Medicine.
Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through our partnership with MedStar Health). Our mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis--or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, and the world renowned Lombardi Cancer Center.
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Academic Medicine