Kanter, Steven L. MD
One day, about 30 years ago, when I was a third-year medical student rotating on psychiatry, the ward team was discussing the differential diagnosis for a patient with a complex set of problems. As we struggled with various aspects of the case, the attending psychiatrist looked at us and said, “Use your own emotional reaction to the patient as yet another piece of information to help you formulate possible diagnoses.” I was struck by this comment because it flew in the face of everything I had been taught up to that point.
Indeed, the psychiatrist's recommendation was radically different from what I had heard from any other faculty member. One highly-respected internist often would say, “When it comes to patients, think with your head, not with your heart.” Another revered attending surgeon frequently advised, “Be objective when dealing with patients and do not let your own emotions interfere in the patient-doctor relationship.” “Keep your own emotions at bay lest you become too involved,” another warned.
There is value, of course, in this advice, which has been passed down through generations of physicians. It is important to make decisions based on the best available evidence, to ensure that emotions do not cloud the interpretation of objective data, and to refrain from inappropriate emotional involvement with patients.
And yet, I thought, the attending psychiatrist was on to something important. I knew that I and several of my fellow students were feeling a myriad of emotions every day, some rather intense. It made perfect sense that we should experience such emotions, given the very close and personal way that we were beginning to interact with other human beings to gather data that could help translate their suffering into recognizable syndromes, conditions, and diagnoses. And it made sense that each of us might be able to use his or her own emotional response to a patient as a valuable aid to medical diagnosis.
The attending psychiatrist went on to explain that he noticed that he felt some anger toward patients who ended up with diagnoses of depression. He was careful to point out that he did not act on his feeling but, instead, converted it to useful information that had the potential to inform a differential diagnosis.
Today, as an editor, it is gratifying to see an increasing number of submissions to this journal about the role of emotions in educational and clinical settings. In this issue, Shapiro considers whether the current approach to educating physicians fosters strategies of ignoring, distancing, and detaching for dealing with emotions rather than trying to understand, attend to, and work skillfully with them.1 Artino and Durning point out that we know very little about how emotion relates to learning. They suggest that medical educators can learn from studies in the field of educational psychology, and join the call for more research on the role of emotion in learning.2 Elnicki notes that there likely will be a large number of variables and confounders in such studies, thus requiring careful attention to methodology.3
Last year, the journal published an article by Lown and Manning on Schwartz Center Rounds, a technique that incorporates consideration of health care provider emotions to enhance communication, teamwork, and provider support.4 In this issue, these authors reinforce the idea that there are benefits for health care providers when they recognize and reflect on their own emotions, perceptions, and other reactions that occur during patient encounters.5
So, yes, it is critically important that emotions do not cloud the interpretation of objective data, but that does not mean that one's own emotions cannot add important information to the interpretation of that data. As Lown and Manning point out, a health care provider's more sophisticated sense of his or her own emotions may have the potential to decrease stress, to enhance psychosocial health, and to augment team function.5 And, if my psychiatry professor was right, understanding one's own emotional reaction to a patient may even be able to improve diagnostic accuracy.
Steven L Kanter, MD
1Shapiro J. Perspective: Does medical education promote professional alexithymia? A call for attending to the emotions of patients and self in medical training. Acad Med. 2011;86:326–332.
2Artino AR, Durning SJ. It's time to explore the role of emotion in medical students' learning [letter]. Acad Med. 2011;86:275.
3Elnicki DM. [Reply to letter]. Acad Med. 2011;86:275–276.
4Lown BA, Manning CF. The Schwartz Center Rounds: Evaluation of an interdisciplinary approach to enhancing patient-centered communication, teamwork, and provider support. Acad Med. 2010;85:1073–1081.
5Lown BA, Manning CF. [Reply to letter]. Acad Med. 2011;86:276–277.