Doctors have feelings, too

Danielle Ofri is one of those women who sets the bar awfully high for the rest of us. She's a doctor in New York with three kids, ages 7 to 12, and a husband who works. She manages to write books and edit the Bellevue Literary Review, which publishes creative writing about healing. She takes cello lessons.

But this article is not about how Ofri's productivity makes us feel.

It's about how patients and the practice of medicine make her and other doctors feel. That is the subject of her fourth and latest book, What Doctors Feel: How Emotions Affect the Practice of Medicine.

She'll be in town Wednesday to discuss the topic at Fox Chase Cancer Center Auditorium. Her talk, at 7 p.m. in the Center Building, 333 Cottman Ave., is open to the public and free. (Registration is required; call 215-214-3954 or e-mail authors@fccc.edu.)

Ofri thinks her ideas will appeal to a general audience, not just cancer patients and their doctors, because illness is a nearly universal experience.

"There is an enormous sense of vulnerability about our bodies and fear of the medical system," she said.

When it came to publishing her work, she thought the logic and science of medicine were well covered. She saw a less-crowded niche in the emotional life of doctors. Plus, it was a way for her to process the intense experience of working in a busy public hospital, where she was stretched to the limit and patients sometimes seemed to have brought on their own misery.

She has written about empathy, shame, guilt, and grief, all of which, she argues, play a key role in the decisions doctors make and the way their patients respond.

"The goal of my book is not to label emotions as good or bad, but to make us aware that they're there all the time," she said. "They're in the air like oxygen."

Ofri, who is now writing a book about how doctors and patients communicate, works as a general internist three days a week to give herself more time to write, so she's not quite a super woman. The writing is her way of acknowledging feelings that she thinks many doctors ignore, at their peril. Buried emotions have a tendency to reemerge in a more damaging form at inopportune times.

"We need to give our emotions their due," she said.

Oncologists have a big challenge. "You can't not be sad when your patients are dying all the time," she said.

Oncologists may need to acknowledge up front with patients that "death is part of this game." Uncomfortable as it makes them, doctors should ask patients to talk about their fears and how much they want to know. Some patients may need to be in denial in earlier stages of the disease and become more realistic at the end. Doctors have the difficult task of helping them negotiate the transition from fighting the disease to accepting the inevitable.

Ofri has written movingly about how horrible she felt when she made a mistake that might have hurt a patient. In one case, she failed to check a CT scan and missed an intracranial bleed. The patient was all right, but "I was appalled at myself, mortified by my negligence," she wrote in May in the New York Times. "I stumbled through the rest of the day, an acrid mix of shame and guilt churning inside me."

She said doctors need to learn to admit their mistakes, but that will happen only if more-experienced doctors show those in training that it's acceptable by admitting their own mistakes.

"It's OK to come forward," she said. "This is the human condition."

While some might argue that the most important thing about a doctor is his or her competence, Ofri thinks there's nothing wrong with considering the emotional connection between patient and doctor. That might make the doctor a better listener, which might lead to better decisions.

"I don't think we have to, as patients, accept a doctor who's really smart but is a jerk," she said.

"There are plenty of doctors who are smart and are not jerks."