"When I was pregnant with my first child, I had to get an ultrasound and an amnio but I couldn't find the office. I walked up and down the hallway of my own hospital and I couldn't find where I needed to go! I was so lost and no one was there to help me. It was so unnerving. Now I think about my own patient who has six tests to do and doesn't speak English, or is frightened -- and then we say, "They're not compliant." There's so much involved in being a patient we don't think about." -- Dr. Danielle Ofri
(Dr. Danielle Ofri, Photographer Joon Park)
In internist's Danielle Ofri's latest book, What Doctor's Feel, she explores the emotions doctors shoulder -- from feeling an exaggerated sense of responsibility for their patients wellbeing to the shame of medical errors, to how empathy is being trained out of medical students.
Ofri is by accomplishment extraordinary and in her writing humble. She is a 20-year internist at Bellevue Hospital, associate professor of medicine at NYU School of Medicine and editor-in-chief of the Bellevue Literary Review. She traveled extensively in Central and South America to learn Spanish because that's the native language of most of her immigrant patients, takes cello lessons, is a wife and mother of three, a regular contributor to the New York Times health section and the author of four books.
Ofri's books explore the "other world" of medicine -- emotions. Writing, Ofri told me, "began as a way to walk through some intense experiences and process my feelings." Her books are also "thank yous" to her patients who have taught her how to, and made her a better, doctor.
Ofri provides a window into her own, and many fellow doctors', emotional experience caring for patients. Daily we are learning that the quality of connection between patient and physician impacts health more than we realize, as well as patient outcomes. Now we can begin to understand how emotions impact medical professionals' health, and performance.
Ofri's unchanging sentiment about empathy can also be found in her second book, Incidental Findings: Lessons From My Patients in the Art of Medicine.
I've often wondered, what makes it so difficult for doctors to envision patients beyond their role as sick people? When we gaze at our patients in those awful blue gowns, camped on that ultimate symbol of infirmity, the hospital bed, it seems impossible that they ever had other lives. We can't imagine them running for the subway, balancing a checkbook, shouting down an underling, changing light bulbs, having sex.
Is our vision clouded because we are so immersed in the world of sickness? Is it because this helps reinforce the power dynamic that has kept patients "in their place" for centuries? Or might it be because, like Mr. Karlin [patient featured in the book] we doctors are scared down to our bones? If we were to see our patients living the lives that we live, then there would be nothing to separate them from us. And then we could easily become them. (Page 93)
I had the pleasure of sitting in Dr. Ofri's apartment discussing the doctor-patient relationship while sipping a cup of cappuccino she made for me. This is part one of a two-part interview.
Riva Greenberg: As you wrote about in What Doctor's Feel, why do medical students lose empathy during their training?
Danielle Ofri: I think it's not about who we select to become doctors. Medical students come in with all the right traits. They're eager, caring, desperate to help, but then too often come out of medical school jaded. Oddly, their empathy seems to erode just as they're starting to work with patients in their third year. Empathy doesn't solve medical problems, but you can't solve them without it.
RG: Why do they lose empathy?
DO: The first two years of medical school are classroom years and the third and fourth are clinical. When you first get to work with patients, there's lots of pressure. You're constantly being tested, disrupted, you're disoriented and no one's paying much attention to how you feel.
During your training you typically don't stay in one place so you have to keep getting used to new patients, nurses, the system, the set-up, the computer. Then, just as you start getting used to things, you're moved again.
Some schools are changing this by having students stay with patients for a longer period of time both in and outside the hospital. But, clearly, we need to pay closer attention to this crucial time and change the prototypical training. Most of all, perhaps, we have to let students experience forming relationships with their patients and being on a shared journey.
RG: You've written about how giving birth to your daughter gave you an appreciation of what it's like to be a patient. It seems doctors often forget what patients feel, especially in a hospital setting.
DO: Having my baby was a real education, and I was in my very own hospital! First they starve you before you give birth, so when I finally got back to my bed I was famished and thirsty beyond belief. They put this tantalizing frosty pitcher of water on my bedside table -- just out of reach! My whole universe became about this pitcher of ice water I couldn't reach. I even tried to lasso it with my pillow, but that didn't work.
I didn't want to page the nurses because I know they're busy and people are sick, but after several minutes I finally asked someone if someone could come and give me some water. No one came so I broke down and called the nurses station. Five calls later I did what I promised myself I wouldn't: I pulled rank. "I'm Doctor Ofri," I barked. "I'm a faculty member here and I need someone to give me a glass of water!"
It made me realize just how vulnerable and dependent patients are. There are so many simple things all of a sudden you can't do. I remember an incident where a patient had asked me for a Ginger Ale. I thought at the time, I'm juggling 20,000 important things and this is what you're asking me for?
Now I know if my patient gets that Ginger Ale it makes all the difference in the world. And not just because they can drink something, but they know they're going to be taken care of. On rounds now, I'm constantly fussing with the bedside table, moving the phone and the tissue box to where patients can reach them. These are small things, but they can feel so important when you're sick.
RG: In your first book, Singular Intimacies, you wrote that you asked a patient if she would share with you how you could be a better doctor. Have your patients helped you become a better doctor?
DO: Absolutely. One patient -- I called him Mr. Moreno in Medicine in Translation -- is an older gentleman I've seen since I was an intern. He has diabetes, hypertension and heart disease, and his cardiologist wanted him to get an implantable defibrillator to prevent further problems.
He asked me what to do. I told him to do it since it was a very low-risk procedure. After the operation, however, he got every complication possible. The defibrillator went off at the wrong times, they had to put him on more meds that had side effects, he had impotence and incontinence and his diabetes worsened. It took him a year to recover.
What I learned is even with the limited time we have, you have to find out what patients regard as important to have a good life. I had considered his heart, but not him.
My other patient, Julia -- whose story I began in Medicine in Translation, and follow more fully in What Doctor's Feel -- gave me the gift of sharing a wide-angle lens on her life and taught me to be on a journey with a patient. Now whether I see a patient for years or only a few visits, I'm committed to being on a ride with them.
As our health care system struggles to improve patient care, lifting the veil on what health care providers experience emotionally, should be required study. What Doctors Feel gives us a valuable insider's view how emotions help and hinder health professionals' ability to deliver the care they're charged with.
In part two, Dr. Ofri talks about medical errors and the shame that keeps them ongoing.
Riva's new book, Diabetes Do's & How-To's, is available in print and Kindle, along with her other books, 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It and The ABCs Of Loving Yourself With Diabetes. Riva speaks to patients and health care providers about flourishing with diabetes. Visit her website DiabetesStories.com.
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