Tuesday, April 3, 2012

Emotions: Too Much or Too Little?

"If we feel our emotions deeply, we risk recoiling or breaking down. If we erase our emotions, however, we fail to care for the patient. We face a paradox: feeling prevents us from being blind to our patient's soul but risks blinding us to what is wrong with them (Groopman 45)." 

After reading Chapter 2 "Lessons from the Heart," in How Doctor's Think by Jerome Goopman, I am left asking myself how doctors should approach patients from an emotional standpoint. Groopman offers many examples where having no emotion or too much emotion can both lead to negative health outcomes for the patient.

On page 45, Groopman discusses that doctor's seek patient cooperation in order to feel successful  -- "Physicians like to succeed in their treatment, and an essential ingredient for that success is a patient's cooperation." Therefore, doctors do not want to help patients who do not want to help themselves, as their efforts will yield no results.  However, given Groopman's examples, it is evident that a doctor's quick judgement and influence of stereotypes can lead to terrible assumptions that lead to unwanted results. This is seen in the opening discussion of Anne Dodge, who is thought to be disregarding her doctor's order to have a caloric intake of 3,000 calories per day consisting of cereal, pasta, and bread, in order to cure her anorexia/bulemia. However, it takes careful examination by Dr. Falchuk to determine that her obedience to her doctor's orders actually caused her body to deteriorate even more as she had celiac's disease. The intial doctor's lack of emotion and frustration with Anne Dodge's "uncooperativeness" led to her misdiagnosis, as she was confined to her initial diagnosis without further investigation towards the real problem. 

However, on the other hand, we see in Groopman's discussion of his patient, Brad Miller, that having a very close relationship with a patient can lead to making decisions that can also lead to negative health problems. In this scenario, Groopman becomes close to cancer patient Brad Miller and does not fully examine him during rounds because he does not want to cause him any more discomfort. However, as Groopman later explains, his decision to spare him some discomfort led to an infection that caused Miller's white blood cell count to reach abysmally low levels. In this case, Groopman's concern for his patient led to him make a decision based on his friendship, rather than what was best for his patient.

After looking at these examples, it begs the question of how doctor's should approach treating their patients. Groopman ends the chapter by stating that doctor must remain neutral and unbiased in treatment. We often don't think of how a doctor's emotions can affect the care that they give their patient, but after Groopman's discussion and the class lecture, we ask ourselves "what makes a good doctor?" From these examples and those given in class, a good doctor is able to maintain an open mind, give unbiased care to all, disregard stereotypes, and be creative and not confined to what Groopman calls "paper cases" where medical students follow flow charts of symptoms that led to clear cut diagnoses.

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