Working in healthcare can be an emotionally draining experience, and COVID-19 has served to underscore that fact. Clinicians, after all, are human beings with feelings, just like everyone else. Historically, however, it’s been considered unprofessional for medical providers to express emotion in front of their patients.
This, in turn, has led clinicians to suppress and ignore their feelings, sometimes to the detriment of their own mental health. And, as it turns out, many patients are left feeling dehumanized by their doctor’s detached demeanor.
So what’s a clinician to do? The role of healthcare providers’ emotions in medical practice is catching the attention of researchers and the recognition of medical schools alike. The way physicians manage their emotions in a clinical setting can affect both the physician and the doctor-patient relationship.
Common physician emotions
Working in the medical profession brings about numerous pressures that mainly occur as a result of dealing with people at their most vulnerable, experts note. Physicians routinely witness pain and suffering, and they encounter death. Empathy and compassion are also central to the role of the physician.
Many situations that a physician encounters—giving bad news to a patient or their family, for example—can provoke emotional responses from doctors.
A doctor may experience guilt, sorrow, anger, lack of control, or feelings of failure when dealing with a terminally ill patient. Or they may also rejoice when they share good news and when patients are successful in their treatment goals.
If doctors deal with demanding patients, they may feel angry or overwhelmed. Or, if a patient isn’t taking their medication, the prescribing doctor may feel frustration.
Concerns about patient suffering or death may cause a clinician distress or sadness or even lead to depression. A clinician may also experience grief if they encounter a patient who reminds them of a loved one who has passed away from a similar illness.
Fostering the doctor-patient relationship
Specific clinical situations can lead to emotional responses, and some emotions may positively or negatively affect the doctor–patient relationship. For example, research on physician emotions shows that experiencing intense emotions in a patient’s presence is common. These reactions have the potential to alter the clinical relationship, depending on the physician's response.
One Permanente Journal study published results from self-reported physician surveys and found that 43% of the physicians reported experiencing intense emotions frequently. While most physicians said they tried to control their feelings, many reported not always handling themselves appropriately.
Physicians also shared that they felt their emotions impacted the doctor–patient relationship. Choking up or crying, smiling, and providing support were viewed positively by patients, but withdrawing, imposing, and defending oneself were perceived negatively.
Emotional effects of COVID-19
With the continuing COVID-19 pandemic, physicians and other healthcare workers struggle with adverse mental health effects as they attempt to balance caring for their patients and being concerned for the health and safety of their own loved ones.
According to a study published in PloS One that reported on healthcare workers' emotions, stressors, and coping strategies, many healthcare workers experienced significant emotional distress during the first wave of the COVID-19 pandemic. Fortunately, those emotional stressors improved with access to personal protective gear, better pay, and recognition.
For physicians to keep their emotions from interfering with their medical decisions, they need to remain calm and maintain a professional demeanor so that their patients trust they are getting high-quality care. However, some emotion is necessary because patients might see doctors as emotionless if they suppress their feelings.
A study published in Social Psychological and Personality Science found that many patients perceived their doctors as “empty vessels” who were only there to do a job. Many also reported they preferred physicians who took the time to empathize and understand their emotions.
Learning healthy coping mechanisms
Physicians experience many emotionally charged situations, so successful emotion regulation is crucial to well-being, preventing burnout, and reducing compassion fatigue. Recognizing the signs of compassion fatigue is the best first step toward addressing any issues. To mitigate compassion fatigue or to prevent it from taking hold, experts recommend several strategies.
Express your feelings: Stress and pressure come with the job. Doctors should be allowed to feel what they need to feel just like everybody else, and their feelings are not a sign of weakness or an inability to do the job.
Take breaks: If you feel overwhelmed during a patient interaction, it is acceptable to excuse yourself, step outside the room, and resume the exchange once you have composed yourself. It is never appropriate to lose control in front of your patients, but it is always wise to excuse yourself if it happens, and apologize if necessary.
Use self-care coping strategies: Engage in coping strategies that have worked for you in the past. According to the CDC, these might include getting adequate sleep, eating healthy meals, taking breaks to rest, stretching, or connecting with loved ones and colleagues. You might also consider mindfulness activities, such as meditation, yoga, and breathing exercises.
Pay attention to emotional health: Look out for signs of depression, including prolonged or intense sadness, problems with sleep, and feelings of hopelessness. If you feel you are struggling to cope, talk to a trusted colleague or a mental health professional.
Get moving: When you are away from work, get as much exercise as you can. Spending time outdoors, being physically active, or doing what you enjoy during non-work hours can improve your mood and reduce stress.
Consider the importance and meaning of your work: When your emotions are getting the best of you, remind yourself that you chose an honorable field where you help and serve others. Take the time to recognize the efforts and the sacrifices you make every day and how many people appreciate you.
Silva JV, Carvalho I. Physicians experiencing intense emotions while seeing their patients: What happens? Perm J. 2016;20(3):15-229. doi:10.7812/TPP/15-229
Rose S, Hartnett J, Pillai S. Healthcare worker’s emotions, perceived stressors, and coping mechanisms during the COVID-19 pandemic. PLoS ONE. 2021;16(7):e0254252. doi:10.1371/journal.pone.0254252
Healthcare personnel and first responders: How to cope with stress and build resilience during the COVID-19 pandemic. Centers for Disease Control and Prevention.
Schroeder J, Fishbach A. The “empty vessel” physician: physicians’ instrumentality makes them seem personally empty. Soc Psychol Personal Sci. 2015;6(8):940-949. doi:10.1177/1948550615597976
Are you experiencing compassion fatigue? American Psychological Association.