Guest: Dr. Danielle Ofri
Guest Bio: Associate Professor of Medicine at NYU School of Medicine, Physician at Bellevue Hospital in New York
City, Editor-in-Chief of the Bellevue Literary Review and Author of four books, including her most recent:
What Doctors Feel: How Emotions Affect the Practice of Medicine.
We discuss Dr. Ofri’s most recent book, entitled How Doctors Feel: How Emotions Affect the Practice of Medicine.
Health professional Radio – Emotions and Practice of medicine
Emily: You’re listening to Health Professional Radio. This is Emily, and my guest today is Dr. Danielle Ofri. She’s an Associate Professor of Medicine at NYU School of Medicine, a physician at Bellevue Hospital in New York City, editor-in-chief of the Bellevue Literary Review, and an author of four books, including her most recent, “What Doctors Feel: How Emotions Affect the Practice of Medicine.” Dr. Ofri, thank you so much for speaking with me today.
Dr. Danielle Ofri: Thank you. It’s a pleasure.
Emily: Let’s talk about your new book first. “What Doctors Feel: How Emotions Affect the Practice of Medicine.” Tell me about that title.
Danielle: I think we all assume that doctors are completely rational and scientific. After all, we wear white coats just like laboratory researchers. But I think in my years of medicine I have noticed, and many others have too, that we are far less rational than we tell ourselves, and certainly than we tell our patients, that emotions play an enormous role in the doctor-patient encounter. I wanted to take a look under the white coat and see what’s ticking.
Emily: Yeah. I love that. As I read through it – I’m not a physician, and I at once had this sensation of never wanting to set foot in a hospital again and also picturing myself in the examination room, looking into the face of a human being who has feelings and stressors. It really humanised that encounter for me. Go ahead.
Danielle: Well, if you were feeling sick, you could type in your symptoms into a computer and it would probably spit out a fairly accurate diagnosis, but it’s hard to imagine that most of us would really want that. We wouldn’t feel taken care of. We wouldn’t feel healed. It would feel very sterile, and I think, especially when we’re sick, we crave and want and need a real human being, a doctor or a nurse who brings both scientific knowledge and all the other stuff that makes us feel taken care of.
Emily: Right, because there’s so much more to medicine than simply the diagnosis, the drugs, those kinds of things. Right, absolutely. Your writing strikes me as so honest and, in a way, it’s so gentle, as though you have come to a point where you’re able could be gentle with yourself and with other doctors and with your patients, and you walk us through your experiences with emotions like fear and stress and shame. There’s a point in the book where you describe being humiliated and shamed by a senior resident for a mistake that you made.
You write that now when you witness a similar situation to the one that you say took you 20 years to be able to write about, that being a bystander, in your words, is no longer an option. Is that kind of what you hope to accomplish with this book?
Danielle: Absolutely, yes. I think many of us know this intuitively, but we don’t talk about it explicitly. We see it happening. We know it’s not right, it feels wrong, but we don’t really talk about it. I think the only way to make a dent on this is to be explicit, as I hope in the book. My experience of being humiliated by a senior so affected me that if I witness it, I can’t be a bystander.
I need to intervene, and there’s never any excuse of humiliating someone. Someone may have made an error, and we need to correct that and not make it again, and acknowledge that and take responsibility, but shaming someone in public has no role in medicine.
Emily: Right. It’s so prevalent in any profession, really. I think we all know that feeling of having not lived up to the expectations of a supervisor or, as you point out, our own image of ourselves, and that that is what perhaps hurts the most sometimes – is when we set ourselves up on these pedestals to achieve some sort of heroic status that we simply cannot be expected to sustain.
Danielle: This is particularly prevalent in medicine, which already selects for perfectionists, and then trains and promotes perfectionism. Really, you’re either a good doctor or you’re a lousy doctor, and there’s nothing in between. You can’t be a good enough doctor. So when we make an error, not only is it feeling upset that we made a mistake and potentially harmed a patient, but it’s shattering for ourselves because we have no way of handling human imperfection. We now are a failure.
For many doctors this can be devastating. Again, usually errors occur with good doctors. There are probably a few quacks out there, but mostly errors occur to caring and competent doctors and nurses. So when they feel their inner self shattered, we may be losing very good practitioners.
Emily: Right. I love that concept of the apology that you’ve come around to in the book when you describe going to a patient and saying, “I need to apologize. I made a mistake.” I feel as though that’s really the culture that your book insinuates we need to be moving toward, is being able to accept, own up to, talk about those short comings, so that others can learn and so that that shame and that fear does not lead to future mistakes.
Danielle: It’s not easy, and in the first mistake I wrote about, I could not, in a million years, have dragged my sorry self into the patient’s room and told them. I was so ashamed, I was young and inexperienced, I didn’t have the fortitude, and certainly I didn’t have any guidance. A senior doctor didn’t come to me and say, “Listen, let’s go together. We need to tell the patient, as hard as it is.” Partly there’s fear of lawsuits, but increasingly studies show that doctors who own up are much less likely to get sued. In fact, patients are less likely to dump their doctor if a doctor makes an error, because they know that mistakes happen, and what they want most of all is honesty and reassurance.
If a doctor comes forward and talks about a mistake, the patients feel they can trust them even more. But years later, I know it’s still not easy, but I’ve gotten a little bit better at telling a patient, “You know, this is what happened. I have to tell you.” Mostly patients are so relieved, rather than angry, because they want to know they can trust you.
Emily: Right. Your book certainly presents that in such a beautiful way. You give a couple of examples of watching other doctors and nurses exemplify empathy, and you give the story of first night on call in the ER, and an aide who showed so much compassion and empathy to a woman that you were struggling to approach, and it’s just beautifully written. I think for me, the description of your struggle is as powerful as the description of her kindness. Would you agree with that?
Danielle: I was a first year student medical student with no clinical exposure, and I was volunteering as a rape crisis counselor. It was my very first call, and the patient was a homeless woman, very dishevelled. As I approached her, the smell was so powerful that I couldn’t do it. I simply couldn’t get past my nausea at the smell, and then a roach crawled out of her clothing, and I was so horrified that I backed away and I really cowered in a corner, unable to get past that. I was thinking, “How will I ever be a doctor? Aren’t I supposed to be helping any patient?”
But then I watched an older nurse aide walk over to the patient, and I knew she was smelling the same smell, and she put her arm around the patient and said, “Let me help you. Let’s go get you washed up and get some clean clothes. It’s okay, I’ll be with you.” The patient went with her, and that small moment was such a powerful lesson that I’ll never forget. I don’t know the name of that aide, but what she did, she gave of herself and it really impacted me a lot.
It also reminds me to tell medical students that lessons are everywhere, not just from your own professors. All around are lessons for better, in this case, and also sometimes for worse.
Emily: Do you see in your own students yourself in your early 20s? Do you see them coming to the practice with a different attitude or more empathy as a result of sharing these stories and perhaps learning from others’ mistakes?
Danielle: Well, I certainly see that students come into medical school with lots of empathy and caring. They come in with all the right ideals. I think at this point in our society we’ve weeded out those who go into medicine for money, those folks have gone off to the Wall Street. So the students who are coming in have all the right stuff. But somehow during their training, these ideals get beaten down, and at the other end they’re much more jaded. I’ll see it especially when it’s with patients who have illnesses that appear self-induced. Alcoholism, addiction, obesity.
I find many medical trainees and senior doctors have a lot of trouble finding empathy for these less likeable patients. So it’s very important for us in the teaching position to point that out and to demonstrate even when it’s difficult, or the patient who is obnoxious, let’s say, or angry or abusive, that we need to still figure out a way to connect with the patient, because they’re the one who is sick and is vulnerable, and we have to really get around that.
Emily: Do you think that the acknowledgment of those shortcomings perhaps in our own compassion is the starting point to begin those kinds of transformations?
Danielle: Yes. I think this is the kind of thing we can only learn by seeing it occur in our role models. You can’t really talk about this sort of stuff in a PowerPoint presentation or a lecture or some outside consulting group. It’s all meaningless words. We have to see someone higher up, someone with seniority take the time to speak to the patient respectfully, to talk to the nurse respectfully. To acknowledge errors to people lower than them. Say, “Oh, I made a mistake. You, the intern, the student, you got it right. Maybe I’m the one who made the mistake.” Those are powerful lessons that we don’t forget.
Emily: Right. You describe in your book a lot of the terrifying realities of your profession. I think that although you also described some of your proudest moments, it’s your openness about the scary stuff, about the sad stuff, that really connected me to your book and, I can imagine, would connect other students and engage other doctors in those same kinds of conversations.
Danielle: I hope so, because I really want to make explicit what we all sense, somehow a sixth sense, but don’t really talk about, and that if we don’t give these emotions their due they’ll simply come out at a later time. They don’t go away when you’re traumatised or grieving or if you’ve been shamed. Those will get bottled up and will reappear someplace else, often in a maladaptive way that we then start shaming someone else or we don’t respect our patients.
Emily: Right. I don’t want to give out the ending of the book, but I will say that as you acknowledge this grief, overwhelming responsibility, as you said shame, fear, trauma, the book feels triumphant to me. After having read it I feel so much lighter. Do you feel that way?
Danielle: I’m very optimistic because I see who is going into medicine, who is going into nursing, people who really care. By and large the medical professionals are committed, confident, caring. I think our job as institutions is to preserve that and promote it, allow it to flower, not beat it down. So that’s our job, to offer a respectful environment, and that will help our patients.
Emily: Right. Who is this book for?
Danielle: It’s for a general audience, and I include doctors and nurses in the general audience. I think they should read it as professionals, but I want people who come to doctors’ offices to have the sense of what’s going on. I think that patients intuit when things feel off, when their doctor seems pre-occupied or is disrespectful or is not giving them much time of day – they know it.
They may not be able to put their finger on what’s wrong, and this might help them see what’s happening. If they feel comfortable, they counter the doctor. “Hey, you don’t seem to be listening to me or looking at me when we talk.” Or maybe afterwards they talk to someone in charge or to find a different doctor who will be able to focus full resources on the patient.
Emily: Right. I think it’s a beautifully written book. I loved every chapter, every word of it, and I’m sure that others are going to find a similar connection. Congratulations to you and best of luck with that book.
Danielle: Thank you so much.
Emily: You’re listening to Health Professional Radio. This is Emily, and my guest has been Dr. Danielle Ofri, the Associate Professor of Medicine at NYU School of Medicine and a physician of Bellevue Hospital in New York City. Dr. Ofri is an editor-in-chief of the Bellevue Literary Review and an author of four books, including her most recent, “What Doctors Feel: How Emotions Affect the Practice of Medicine.” Dr. Ofri, thanks so much for speaking with me today.
Danielle: It’s a pleasure.