Editor’s Note: This article originally ran in the Courier-Post on April 8.
Kim Mulford, Courier-Post
Nearly every day at work, Dr. R. Phillip Dellinger encounters death.
A doctor in the intensive care unit at Cooper University Hospital in Camden, Dellinger has made peace with it.
But even he sometimes chokes up when talking with family members of patients who have died.
“If you get too emotionally involved, it definitely would compromise your ability to take care of a large number of patients,” said Dellinger, chairman of the department of medicine at Cooper Medical School of Rowan University and medical director of Cooper University Health Care’s Adult Health Institute.
“But at the same time, you need to be willing to show emotions and empathy where it’s appropriate to do so.”
From their first hands-on interactions as medical students, doctors teeter between dispassionate intellect and their all-too-human emotions, from fear and frustration to grief and compassion.
How they handle that balance can affect patient care, explains Dr. Danielle Ofri, author of “What Doctors Feel.”
A doctor at New York’s Bellevue Hospital, Ofri will speak Wednesday on the topic at Cooper Medical School.
She started exploring the interior lives of clinicians after asking her colleagues what made them the doctors they are today. None cited a textbook but instead described intense patient encounters.
“All revolved around a powerful human emotion,” Ofri said. “These are the stories that shape us, that change who we are and determine how we practice medicine.
“We use evidence-based medicine and run big clinical trials, but I think what most of us who practice medicine realize is … that a lot of what we do is influenced by our emotions.”
Historically, doctors’ emotional responses have not been often processed or openly discussed, Dellinger said.
“It’s a little bit like the elephant in the closet,” he said.
Take grief, for example. An oncologist’s emotional responses over a bad outcome can affect the cancer treatment plan the next patient receives. Doctors might overcompensate and treat the next patient more aggressively, she said, or scale back treatment if a patient died a “miserable, machine-laden death they wanted to avoid.”
Doctors compare getting hit with a malpractice lawsuit to a death in the family or to spousal infidelity, she said. That can lead to overly defensive medicine and a tendency to order too many tests.
“We’re very leery of trusting again,” she said. “We don’t want to be hurt again.”
But doctors agree there are many times when empathy and compassion are helpful to patients.
Lourdes Health Foundation recently awarded its annual Healing Spirit Award to Dr. Ronald Cohen, an interventional cardiologist at The Heart House/Cardiovascular Associates of the Delaware Valley, and Dr. Stuart Mest, a pulmonologist and chairman of the department of medicine at Lourdes Medical Center of Burlington County.
Both men encounter patients and their families when they are most vulnerable, physically and emotionally.
“They’re angry, they’re scared, they’re not happy obviously with their situation,” Cohen said. “I respect their vulnerability. I try to be supportive but also professional and deal with the task at hand.”
It’s the little things that count: making eye contact, facing the patient, taking a moment to ask about their family. Patients sense when a doctor cares, said Mest, “and I think there’s a better response to treatment.”
Ofri argues doctors need to take care of themselves emotionally, to be aware of their feelings and how they can affect their work. That can happen through a doctor’s own support network, perhaps by talking with a supportive spouse at home. Sometimes, it can happen more formally, through a hospital’s crisis response team.
Dellinger recently organized what’s called a “Schwartz Center Rounds” panel to discuss the social and emotional issues surrounding Cooper’s care of a young pregnant woman who spent three months “at death’s doorstep.” The panel included her father, a nurse and a doctor.
The questions they pondered were: Should doctors tell a father they think his daughter will die? Does that take away hope? And how important is hope?
“I think there needs to be a balance between reality and hope,” said Dellinger. “I don’t think you can totally do away with reality, but don’t think you should do away with hope.”
The woman and her baby survived, and she returned to Cooper to get married in the hospital’s chapel.
Such happy endings are balm to a doctor’s soul.
“For me, it’s a privilege to be a doctor,” Cohen said. “We’re rewarded in many ways, but the greatest is the emotional satisfaction for a job well done.
“I really do look at it as a privilege.”
Reach Kim Mulford at (856) 486-2448 or email@example.com. Follow her on Twitter @CP_KimMulford
If you go: Dr. Danielle Ofri, author of “What Doctors Feel,” will speak from 12:30 to 2 p.m. Wednesday at Cooper Medical School of Rowan University, 401 S. Broadway, Camden. The lecture is funded by the Berkowitz Family Foundation.