A doctor reflects: 'How do you eat a sandwich after pronouncing a man dead?'

Analytical thinking sometimes means being emotionally distant

Doctors must be both analytical and emotional, but finding a balance can be draining. "How do you eat a sandwich after pronouncing a man dead?" Dhruv Khullar asks in The New York Times' "Well" blog.

Khullar, a resident physician at Massachusetts General Hospital and Harvard Medical School, remembers pronouncing a man he had treated dead: "I felt for a pulse and tested for basic reflexes, searching for any sign of life. Then I walked out of the room and, minutes later, rejoined my medical team to continue our rounds," he writes.

From the hallway, he could hear the man's family sobbing. He couldn't concentrate and considered taking a break. "Is 15 minutes enough to forget that our patient died and his family mourns?" he recalls thinking.

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Doctors can leave work after telling "a young man's family he won't get the liver he needs to live," and then "just hours later—disturbingly, curiously, miraculously—[have] dinner with a co-worker," Khullar notes. But for him, leaving isn't the hard part. "The hard part is leaving one patient's story behind when you turn to the next."

Effect on doctors

This type of "emotional turbulence" is part of what it means to be a doctor, Khullar says. But it can also lead to burnout, which is why many hospitals are investing in wellness programs that promote mindful meditation, group discussions, and other techniques. "These programs have shown positive, sustained effects on provider well-being," Khullar explains, "with research suggesting they help doctors find meaning in their work, reduce symptoms of burnout, and promote patient-centered, humanistic care."

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But Khullar says the tension between feeling too much and feeling too little is not "an unintended, unwanted, modifiable consequence of the job. It is the job." And doctors find ways to cope—because they have to.

For example, doctors' empathy for patient suffering appears to dull over time. In one study, brains scans of physicians who were watching videos of needles being inserted into patients showed that, compared with non-doctors, they had less activity in the region of the brain associated with empathy and more activity in the part of the brain related to executive function.

Finding a balance

But this type of emotional distance can be helpful. Emotional and analytical thinking can interfere with one another, Khullar explains. Dulling emotional pain "can help free [physicians'] analytical minds to more effectively act, advise, cut, diagnose, and treat—often under conditions of great uncertainty."

The lesson, Khullar says, is that it is hard for doctors to be both analytical and emotional at the same time. Instead, what physicians must learn to do is toggle between the two. "Being an effective doctor—like being a good friend, parent, spouse, or colleague—depends on our ability to explore and enrich both sides of ourselves at different moments in our lives," he concludes (Khullar, "Well," New York Times, 12/10).

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