The doctor-patient interaction is fundamentally a human connection, and emotions are a de facto part of it. The goal of this book has been to attune both doctors and patients to the emotional basso continuo of this interaction. For doctors—especially for those in training—it is critical to be aware of the potent influence of emotion on our “rational” decision making. Remaining cognizant of our emotions, being attuned to their fluctuations, understanding how best to integrate them in the moment of connection with a patient will offer the patient the most solid and trusting setting.
For patients—and all of us doctors are of course patients at one time or another—it is one more tool for maximizing the quality of medical care. Keeping your inner ear open to the emotional subtext—both yours and your doctor’s—can help keep the focus on what is most important. “Patients . . . swim together with physicians in a sea of feelings,” writes Jerome Groopman. “Each needs to keep an eye on a neutral shore where flags are planted to warn of perilous emotional currents.”
The shore isn’t always neutral, despite our desire for it to be so, despite Osler’s insistence on equanimitas. Recognizing both the sea and the shore is essential. In this book, I’ve focused mainly on emotions that are often called negative—fear, shame, grief, anger, being overwhelmed—because these are the ones that exert the strongest influence on medical care. But I’m fully aware of the spectrum of positive emotions that exist in medicine—joy, pride, gratitude, even love. These can certainly affect the care that patients receive. Usually these exert positive influences on medical care—doctors who find joy in their work usually do a better job than doctors who are angry, ashamed, or burned out. But even positive emotions have the potential for negative influences. A classic example is doctors who care for friends or family members. The closeness and love can inhibit the doctor from asking awkward questions or doing uncomfortable procedures—asking about sexual history, performing a rectal exam, or questioning drug use, for example.
I chose the story of Julia to weave throughout this book because of the profound and lasting effects she had on me. Besides the roller coaster of medical travails that marked our years together, we also experienced just about every emotion in the dictionary. There were moments of pride, gratitude, humor, and affection. There was fear, anxiety, guilt, and foreboding. I’ve never had a more joyous moment in my medical career as when that new heart was sewn inside her. And I’ve never been more grief-stricken than when it all came crashing down. Even now, years later, when I write about that moment, I need to pause to allow the rekindled grief to settle itself back down. I have shared Julia’s story to honor her memory and also to portray how emotions infuse and affect the doctor-patient interaction at every level.
Doctors often don’t get the distinction between curing and healing, but patients instinctively do. For most doctors, if the disease has been eradicated—well, that’s success. For patients, that’s only part of the process—a significant one, obviously, but not the only one. Plenty of patients walk out of our hospitals, clinics, and offices with their diseases under control, and yet they do not feel healed.
Paying attention to emotions within the doctor-patient interaction doesn’t guarantee healing, no doubt. But ignoring them surely makes it less likely. “Healing is a matter of time,” wrote Hippocrates, “but it is sometimes also a matter of opportunity.”1 Taking this opportunity can be prescriptive for both doctors and patients.
Thirty-six years after Dr. Osler’s “Aequanimitas” speech, Dr. Francis Peabody gave another commencement address to another graduating class of eager medical students. He summed up his ideas in this now famous phrase: “The secret of the care of the patient is in caring for the patient.”2 In this deceptively simple axiom, he encompassed compassion, empathy, and human connection, along with all the medical technologies and therapeutic modalities that a doctor can offer to a patient. Beyond curing, this is what offers the possibility of healing.