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G506(P) Cry a little tenderness? do doctors cry and is this acceptable?
  1. EZA Bassett,
  2. F Finlay
  1. Community Child Health, Sirona Health Care, Bath, UK

Abstract

Aims How common is it for doctors to cry? Do paediatricans cry as a sign of humanity and an expression of compassion? Is crying a weakness, a demonstration of incompetence? Or, in the right circumstance, does it enhance the doctor-patient relationship? A review of the literature will aim to answer these questions.

Methods Literature search

Results Doctors do cry. Sung1 found 69% of medical students and 74% of interns cried at work. Wagner2 reported 57% of doctors, 31% of medical students and 76% of nurses cried. Women were more likely than men to cry.1,2 Medical students reported the highest negative social consequence of crying2 stating it was often viewed as a sign of weakness.3 But views on crying are debated,4 opinions ranging from enthusiastic advocacy, guarded acceptance,5 outright rejection and condemnation.4

The concept of the detached physician6,7, remains alive and well. On the BMA Blog8 doctors debate learned behaviours to distance themselves from emotionally distressing situations.9 Others question if this is healthy4,8,9,10 debating if it is possible to have compassion, without emotion. The Francis Report 201316 highlights the need for Compassion in Practice.17

Patients expect empathy and the demonstration of emotion by their doctor11,12 but only up to a point.13 Hojat14 states it contributes to a better doctor-patient relationship with Anderson15 writing there is nothing wrong with a doctor who makes a patient feel nurtured while still being professional and appropriate.

Conclusion Humanity is the cornerstone of medicine. Depersonalization, with physicians distancing themselves from potentially emotionally challenging situations threatens the core principles of the profession. As paediatricians we need a balanced mix of rationality and compassion with an attitude of humility. We need to teach medical students how to break bad news, cope with baring witness to the dying process, and support those caught in the aftermath. We need to continue this education throughout medical careers while providing physicians with the resources to seek support as they need it.

References

  1. Sung AD, Collins ME, Smith AK, et al. Crying: experiences and attitudes of 3rd year medical students and interns. Teach Learn Med. 2009; 21(3):180–7

  2. Wanger RE, Hexel M, Bauer WW, et al. Crying in hospital: a survey of doctors, nurses and medical students experience and attitudes. Med J Aust. 1997;166(1):13–6

  3. Angoff. A piece of my mind: crying in the curriculum. JAMA 2001; 286(9):1017–8

  4. Pruthi S, Goel A. Doctors do cry. Indian J Med Ethics 2014; 11(4):249–251

  5. Majhail NS, Warlick ED. To cry or not to cry? physicians emotions at the bedside. Minn Med. 2011; 94(1):40–42

  6. Sir William Osler, 1849 1919: A selection for medical students

  7. Lief and Fox. Training for “detached concern” in medical students. The psychological basis of medical practice. New York: Harper and Row, 1963: 12–35

  8. Dawlatly. When did you last cry over a patient? BMJ Blog 18/03/2014

  9. Horn. “I must not burst into tears in front of patients”. What physicians can learn from ethnographers when dealing with emotion. Ethox.ox.ac.uk

  10. Wright JG, Khetani N, Stephens D. Burnout among faculty physicians in an academic health science centre. Paediatr Child Health 2001; 16(7):409–13

  11. Rosenblum JL. Why I still cry. Share a young internist’s reflection on death of a patient at the end of a long day. Med Econ. 2002; 79(13):65–66

  12. Krauser PS. A piece of my mind. Tears. JAMA 1989; 261(24):3612

  13. Friedrichsen MJ, Strang PM, Carlsson ME. Breaking bad news in the transition from curative to palliative cancer care – patients’ view of doctor giving information. Support Cancer Care 2000; 8:472–478

  14. Hojat M, Louis DZ, Markham FW, et al. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011; 86(3):359–64

  15. Anderson. Stand by her: A breast cancer guide for men. 2009

  16. Francis. Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry, London: The Stationary Office, 2013

  17. Cummings and Bennett. Compassion in practice, NHS England, 2013

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