What Doctors Feel: How Emotions Affect the Practice of Medicine by Danielle Ofri (review)

It is interview season for our residency. So I spend a good deal of time reading applications—and if you read one of them, it is like you’ve read them all. They have each trained at a well-recognized institution in biology or neuroscience, done some research, and have volunteered for worthy causes. Their personal statements talk about how they like internal medicine because of its diagnostic dilemmas, and most want to go into technologically sophisticated subspecialties because they are interested in science and/or they want to help people.

The view of medicine espoused in these applications is of a scientist in a white coat seeing patients and, a bit like Sherlock Holmes, figuring out “what is wrong” and making it better. After office hours, they would go into their university lab (they all want to stay in the university) and make scientific discoveries.

This view of doctoring is quite different from my normal outpatient office. There are few diagnostic dilemmas—after practicing medicine for twenty years, most things fall into a few routine categories. What makes medicine interesting and complex are patients’ stories and our relationships. Complicated patients are complicated less because of medical science and more because of their personalities and social situations. Rather than being a scientist, I am often a frustrated social worker/psychologist/friend/counselor.

At the heart of these encounters are emotions. The degree to which I can help patients often depends on the degree to which I bond with them and develop a relationship. More important than my scientific knowledge is my emotional intelligence. Often, when I am having a bad day, it is because my emotions (frustration, anger, sadness) distract me from what the patient is really saying.

In this interesting and very readable book, Danielle Ofri focuses on doctors’ emotions and their central role in doctoring. This is a book that every person who is thinking of going into medicine should read. It describes what it is like to be a doctor and the challenges and joy of the practice of medicine. In particular, she describes physicians as human beings whose “humanness” determines and limits a good deal of their therapeutic effectiveness.

The book is structured around different topics ranging from the socialization of physicians, to death and dying, shame, malpractice, and errors. The topics represent common clinical situations that will resonate with most doctors. What they have in common is that they evoke strong, typically negative emotions. Interestingly, as Ofri admits, the emotions that she focuses on are more negative than positive.

I am not sure why she made this choice and hope it does not scare off medical student applicants. There are many positive emotions involved in doctoring. What is interesting is they may require a broader, more flexible view of doctoring. By that I mean that if being a doctor is focused on curing people or getting the right answer, medicine will often be frustrating, as Ofri discusses in her chapter on shame and mistakes. On the other hand, if being a doctor means serving as an advocate, counselor, or guide, then the practice of medicine is associated with much joy. To the degree to which you are interested in people’s stories, in guiding them through difficult life events, in working to integrate health into their life (rather than making it the only value in their life), the day-to-day practice of medicine is full of small treasures (like the trash talk I hear from Patriots fans or the stories about my patient’s struggle with her teenager). Ofri gives a hint of what that is like as she interweaves the story of Julia, an undocumented immigrant who needs a heart transplant after developing heart failure, between the other chapters.

In each chapter, Ofri discusses both her experience and that of one or two other clinicians. In addition, she does a good job reviewing the literature on each topic, making the book appropriate for an academic environment. Her...