Today’s NY Times has an interesting piece about physicians crying at the bedside. As I consider my career, I do not remember crying at the bedside. Does that make me cold? Which behavior is more appropriate?

At Bedside, Stay Stoic or Display Emotions?

These days, all medical schools have some type of education in topics like the physician-patient relationship and breaking bad news. But knowing how to respond to a personal wave of stress or sadness remains a major challenge. Is crying O.K.? How about hugging a patient who starts to cry?

One physician who cautions against excess emotions is Dr. Hiram S. Cody III, acting chief of the breast cancer service at Memorial Sloan-Kettering Cancer Center. Although Dr. Cody emphasizes the need for doctors “to understand, to sympathize, to empathize and to reassure,” he says his job “is not to be emotional and/or cry with my patients.”

There are two reasons for this stance, Dr. Cody tells young physicians on rounds: It is not therapeutic for the patient, and it will cause “emotional burnout” in the doctor.

These beliefs are shared by many other physicians, but some new data suggest that crying in a medical setting is common among young doctors. At a recent meeting of the Society of General Internal Medicine, Dr. Anthony D. Sung of Harvard Medical School and colleagues reported that 69 percent of medical students and 74 percent of interns said they had cried at least once. As might be expected, more than twice as many women cried as men.

So what should I teach?  How should I act as a role model?

As I consider my job, I often have to deliver “bad news.”  Now bad news is not an absolute concept, rather “bad news” has shades of grey.

I believe that my patients’ deserve my empathy, and also careful explanation.  When I tell someone they have cancer, I then spend a significant amount of time explaining what it means.  I then explain it again the next day, because patients often do not grasp all of my words after I say the C word.

My students and residents have told me that I do a good job of this necessary and painful task.  I take the time to sit down and explore the patient’s understanding and help the patient develop a “game plan.”  If I let me emotions take over, then I believe my effectiveness will diminish.

Delivering bad news is painful.  Before each session I prepare myself using a self visualization technique.  I have learned over the years the art of these conversations.  Each one drains me both because I empathize and I care.  However, crying would detract from my ability to do the complete job of helping the patient.

Perhaps men, and men of my generation are better at compartmentalizing.  Perhaps our maturation process included not openly crying.

I think about my patients.  I do care.  Displaying raw emotion does not work for me.

I wonder if we are doing a good job of teaching our learners about breaking bad news.  Even with the worst news I try to provide hope and support.  We can always do something to help the patient.  Our toolbox includes palliation and emotional support.

I discuss these issues on rounds.  As an attending I consider it my responsibility to be a useful role model.  This includes debriefing every such discussion, focusing on technique, wording, and body language.

As I broke bad news to a patient with a new diagnosis of esophageal cancer last week, I spend a long time each day explaining all the options, what tests we were doing, why we were doing them, and then reporting the implications of the results.  The nursing case manager overheard our discussion, and made a point of remarking how unusual it was to spend enough time making certain that the patient understands the plan, and the process.

I once had a colleague who stressed the importance of maintaining composure when everything seems to be failing.  Patients deserve composure, empathy and a well developed plan.  Maybe they also deserve my crying with them, but I really do not think so.

Related posts:

1. Bedside manner
2. Teaching bedside manner
3. Hippocrates understood bedside manner
4. Breaking bad news
5. Teaching at the bedside

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