My patient was gazing toward the floor as we spoke. She told me that she had not filled the new prescription I wrote at her last visit.
“It’s OK,” I said. “Tell me why?”
“I was afraid that I would have a side effect. You know how I always have problems with new medicines,” she replied, her eyes never leaving the floor.
I was perplexed, as we had spent some time reviewing potential side effects and I emphasized how rare and mild they were. We had even done a “teach-back”— with her repeating the instructions so I was sure she understood everything.
Since knowledge of the listed side effects clearly wasn’t the issue, I gently asked another question:
”What is the worst thing you can imagine happening if you take the new medicine?”
She hesitated, then told me she feared that somehow a new medicine might cause her lung cancer, which she was cured of five years ago, to return.
Not surprisingly, she wept a bit.
Seconds later, and also not surprisingly, she apologized for crying.
I have noticed this pattern for some time now: tears, followed by embarrassment and apology.
In the business world, in sports, and other competitive arenas, many of us have learned to associate tears with weakness.
But crying is a normal and healthy response to distress. And in a doctor’s office, the conversation can get very distressing.
Tears are even thought to have a number of health benefits. They have antibacterial properties and may help flush away irritants to protect the eyes. Crying emotional tears can be self-soothing and is an important way in which we signal a need for support from other people. In addition, crying may help relieve pain and lead to an improved mood. When crying is excessive, it can be an important diagnostic clue to depression, stroke, or other neuropsychological illness.
So the last thing any patient should apologize for is crying. At that point, though, I apologized — for the fact that my prescription for a new medicine had unmasked difficult feelings for her. I thanked her for being honest with me so I could truly support her.
We discussed her treatment and I reassured her that her medications posed no risk of promoting a recurrence of lung cancer. She was visibly relieved. I was, too.
Besides patient-centered, compassionate communication, I have considered other ways to help patients know that crying is acceptable and can even be part of the story my patient needs to tell me.
Exam tables can be awkward and create physical distance, so I prefer to have the patient seated close by in a comfortable chair until it is time for the examination. Keeping computer records is important, but eye contact and physical engagement are essential when the conversation gets emotional. Having tissues in the room, visible and within my patient’s reach, is not a minor detail. It sends a clear message that tears can be part of medical rapport, diagnosis, and healing.
Your doctor should be someone who earns your trust by demonstrating humility and respect for the privilege of clinical intimacy. This trusting connection should extend to your emotional life, as well. If we see your tears, it will be with the highest respect for your privacy and dignity. You owe no apology.
Jeffrey Millstein is a primary-care physician and medical director for patient experience–regional practices at Penn Medicine.