Appendix 10b - Tears for Fears

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

"Medical education does not pay attention to the emotional needs of the physician. We are taught to think, not to feel. No morbidity or mortality conference has time for the physicians' feelings." - Bernie Siegel[139]

Dr. Christine K. Cassel, Chief of Internal Medicine at the University of Chicago School of Medicine, offers some advice. "When people ask me how to cope [in third year] I give them what I think is a very important bit of advice. When you get onto a new rotation, always check to see where the nearest bathroom is. When you feel like crying, you are going to want a place to hide."[140] From Klass's A Not Entirely Benign Procedure:

I cried frequently and helplessly in the hospital.... I was crying because I hadn't slept much and because I had a long day in front of me in which I would be put on the spot and have my ignorance revealed again and again, a day throughout which I would feel tired and sick and heavy handed and inadequate.

We all cry, perhaps, because we are in a harsh environment, an environment that offers us little comfort and in which we frequently find ourselves unable to offer comfort to others.... A friend told me about crying because a patient was dying and she could do nothing to help and everyone kept saying it was a 'fascinating case.'

[Frequently, a medical student runs] the risk of being overwhelmed - by sorrow for others, by tired hopelessness about her own competence, or by helpless anger at doctors whose idea of teaching involves constant tests of strength and occasional humiliation.[141]

Explains one resident, "I find that the residents who get burned out are the ones who are maybe a bit more emotional."[142]

Never apologize for feeling, my friend; to do so is to apologize for truth - Disraeli

From the British Journal of Holistic Healing:

The ethos of the stiff-upper-lip and coping-at-all-costs is learned (by imitation and taboo) early in our training. It is ubiquitous and played extremely hard, particularly in hospitals. How many of us have allowed ourselves to be openly depressed and comforted by a colleague? We are much more likely to maintain a stoical and inscrutable front and urge others to do likewise....

I can only deduce that there is a tact and severe conspiracy of silence regarding this painful area. Traditionally and still reverently, the lack of emotional rapport and support within the caring professions is paradoxical but gross.[143]

One way for students to respond to the conspiracy of silence regarding these issues is to attempt to erase their feelings. This leads to desiccation of the soul, and also to the necessary inference that patients' feelings need also to be erased lest Pandora's Box be opened altogether.

'"You are forced to shut off your emotions.'"[144]

From the New England Journal of Medicine:

A pattern of long hours, no outside interests, no time for family life or vacation, and many other long-standing, unhealthy life attitudes can only result in disturbed emotional adjustments.... During medical training, feelings and emotions are suppressed to prevent the loss of control and to conserve energy required for survival.[145]

According to an article in JAMA, residents' response to stress included tendencies to, "give up humanistic beliefs and to increase emotional detachment."[146] "Support groups and other stress reduction measures are frequently suggested," one doctor writes in the New England Journal, but, "the fundamental problem is not that residents need outlets to their stress. Rather, it is simply that their working conditions create too much stress."[147]


[139] Siegel, BS. Letter. The Pharos 1997(Summer):49.

[140] Cassel, CK. "Musings on Disillusionment." New Physician 1986(May-June):13.

[141] Klass, P. A Not Entirely Benign Procedure. GP Putnam's Sons, 1987.

[142] Durso, C. "Surviving and Thriving." New Physician 1998(October):14.

[143] Zigmond, D. "Physician Heal Thyself." British Journal of Holistic Healing 1(1984):63-71.

[144] James, D. "Deep Impact." New Physician 48(1999):16-25.

[145] McCue, JD. "The Effects of Stress on Physicians and Their Medical Practice." New England Journal of Medicine 306(1982):458-463.

[146] Colford, JM and SJ McPhee. "The Ravelled Sleeve of Care." Journal of the American Medical Association Journal 261(1989):889-893.

[147] McCall, TB. "The Impact of Long Working Hours on Resident Physicians." New England Journal of Medicine 318(1988):775-778.


Reader's Comments

Small point, but it seems that the word "tact" that appears in the Appendix 10b sentence that starts: "I can only deduce that there is a tact and severe conspiracy of silence..." should perhaps be the word "tacit".

-- Floyd Maxwell, January 31, 2000
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