Should doctors cry at work?
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l690 (Published 26 February 2019) Cite this as: BMJ 2019;364:l690
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Balint group experience in medical school - learning to cope with emotional stress
Robison explores the emotional impact of a career in medicine3. Every day healthcare professionals witness patients and their loved ones endure some of the most trying times in their lives. In order to cope with this emotional stress, doctors need to have more resources available to them and this needs to begin in medical school.
A Dutch study found that in the past year, 47.5% of doctors had cried in the workplace1. Reasons may be due to compassion for the patient’s circumstances or having a personal connection to a situation3.
As medical students we get told about the emotional toll that a career in medicine can have, yet we are not equipped with the strategies to cope when these situations arise.
Balint groups are an invaluable tool that gives doctors the chance to talk through difficult emotional patient interactions. A study by Stojanovic-Tasic et al. 2018 found that doctors who had Balint experiences had less ‘high emotional exhaustion’ than those who did not 4.
Few students have the opportunity to experience being part of a Balint group and many have little awareness of what it entails. Henceforth, even if given the option, they would not choose to participate.
Helping us understand our emotional reaction to a situation and aiding discovery of what is lacking in our patient communication, these groups facilitate an empathetic patient-centred approach to clinical practice2.
All medicals students should have the chance to experience being part of a Balint group in order to make an informed choice regarding its individual usefulness.
Balint groups are currently part of some psychiatry training programmes and would be a valuable resource for students to be aware of before starting their careers.
1. Janssens, K. M; Sweerts, C; Vingerhoets, A.J.J.M. The Physician’s Tears : Experiences and Attitudes of Crying Among Physicians and Medical Interns. Journal of Clinical Psychology in Medicals Settings 2019; doi: 10.1007/s10880-019-09611-9. [Epub ahead of print] PMID: 30783989
2. Player, M., Freedy, J. R., Diaz, V., Brock, C., Chessman, A., Thiedke, C., Johnson, A. (2018). The role of Balint group training in the professional and personal development of family medicine residents. The International Journal of Psychiatry in Medicine, 53(1–2), 24–38. https://doi.org/10.1177/0091217417745289 Epub 2017 PMID: 29235909
3. Robinson F. Should doctors cry at work?BMJ 2019; 364:l690. doi: 10.1136/bmj.l690 PMID: 30808662
4. Stojanovic-Tasic, M., Latas, M., Milosevic, N., Aritonovic Pribakovic, J., Ljusic, D., Sapic, R., Vucurevic, M., Trajkovic, G.,Grgurevic, A. Is Balint training associated with the reduced burnout among primary health care doctors?. The Libyan journal of medicine 2018 13(1), 1440123. doi: 10.1080/19932820 PMID: 29493438
Competing interests: No competing interests
Dear Editor,
Yes, I think, doctors can cry, as doctors are human beings too, not artificial intelligence or ruthless workers. You do not need to be a physiatrist to cry, any physicians who are under pressure or who encounter unexpected emotional tragedies or something touch their hearts can cry.
I do cry from time to time, usually not in front of the patients and not excessively. Yes, we all can cry safely without compromising our ability to act. If you feel unbearable pressure then you should hand - over your duty to another colleague. if you feel OK you can go ahead with your duties. However, Self-disclose or not self-disclose would remain controversial(1) and some advocate doctors should not reveal so much (2).
Cry or not cry in front of the patients would remain an option for the doctors.
References:
1. Arroll B, Allen EC. To self-disclose or not self-disclose? A systematic review of clinical self-disclosure in primary care. Br J Gen Prac. 2015;65 (638): e609-616.
2. Sokol D. Doctors shouldn’t reveal so much. BMJ 2018;361:k2495.
Competing interests: No competing interests
Man is an emotional animal. Doctors are human, too. I also cried because of the great work pressure, and tense physician –patient relationship. Professional accomplishment doesn't mean that doctors can't bring emotions into the process of practice, but mean how much rationality you keep while you are feeling.
When you face with injustice, or suffer grievances, definitely you can cry. When you face the parting of life and death, you even can cry face to face. Crying is the release of emotion, why should we suppress it?
Crying is okay, but doctors might cry on proper time and occasions. Try to avoid from patients and other inappropriate situations as much as possible, and to cry when no one else around.
Competing interests: No competing interests
Re: Should doctors cry at work?
Should doctors be able to cry at work? The answer to that question is entirely contextual. There is an absolute difference between crying during an emotionally challenging conversation with the family of a dying patient and crying in privacy because of extravagant workloads and pressure. Regardless of this, doctors are human beings. Professionalism is the bread and butter of medicine, but doctor-patient relationships are formed through shared humanity.
Studies have shown that displays of emotional intelligence improve the doctor-patient relationship [1] and surely the ability to know when it is appropriate to shed a tear in the workplace in a sign of emotional intelligence? If we work on the premises that doctors should be suppressing emotion around their patients, surely we will find ourselves in an era where the “doctoring” might as well be done by robots.
The emotional pressure on junior doctors is so far beyond that of people at similar levels of juniority in other walks of life. Very few other careers expose young adults, new to their profession, to situations where emotions are as heightened as they are, for example, with a family at the bedside of a patient dying of palliative cancer. To cry, whether with the family, or later on in privacy following the encounter is surely an appropriate response to such an experience and an acceptable way to manage negative feeling. If handled poorly, negative emotions such as anger and distress can negatively impact clinical decision making and patient satisfaction [2] so potentially, supressing such feelings rather than finding an outlet for them could adversely affect patient care.
Multiple studies have shown that there are relatively high levels of mental health issues among the medical community. [3] Depressive symptoms have been linked with a greater chance of burnout [4]. If we stop our doctors from being able to cry, a natural release of emotional stress, are we pushing them towards dropping out and leaving medicine all together?
[1] Weng, H., Chen, H., Chen, H., Lu, K. and Hung, S. (2008). Doctors’ emotional intelligence and the patient–doctor relationship. Medical Education, 42(7), pp.703-711.
[2] Lundin, R., Bashir, K., Bullock, A., Kostov, C., Mattick, K., Rees, C. and Monrouxe, L. (2017). “I’d been like freaking out the whole night”: exploring emotion regulation based on junior doctors’ narratives. Advances in Health Sciences Education, 23(1), pp.7-28.
[3] Tyssen, R. (2002). Mental Health Problems among Young Doctors: An Updated Review of Prospective Studies. Harvard Review of Psychiatry, 10(3), pp.154-165.
[4] Rogers, M., Creed, P. and Searle, J. (2014). Emotional labour, training stress, burnout, and depressive symptoms in junior doctors. Journal of Vocational Education & Training, 66(2), pp.232-248.
Competing interests: No competing interests