A patient under our care dies unexpectedly. Another of our patients develops a rare and life-threatening allergic reaction. Another patient commits suicide three months after we last saw them.
All are traumatic and tragic events. If we are in any way sensitive to the relationship we have with our patients, such events have a deep and sometimes lasting impact on our emotional life.
What can we do about a bad event?
After the first shock subsides, a useful step is to begin to capitalize on our capacity for “psychological mindedness.” Some of us possess this gift naturally. For others, this approach to life and to relationships takes some effort. “Psychological mindedness” is defined as our capacity to observe ourselves, paying attention not only to what we are experiencing but also what we observe about our own behavior. When fully developed, we not only pay attention to what we are feeling but what we observe and sense about others’ feelings. Admittedly, our first obligation as doctors is to do our work as competently as possible. However, we always do our work in relationship to another human being so we cannot ignore what is transpiring within ourselves and between ourselves and our patients.
Dr. Ruth Kannai, an Israeli family practitioner, offers an insightful reflection (“It Finally Happened to Me” - PMID: 25201743) on how a capacity for self-observation contributes to restoring confidence after being named in a malpractice action. As a member of a health care organization, she was reassured by her attorney that neither her license nor her personal finances were at risk. Nonetheless, she felt that the suit represented an assault on her integrity. She not only developed the common symptoms of insomnia, self-criticism, flash-backs, and avoidance behaviors but also observed that she had changed the way she practiced medicine.
She describes three clinical situations showing how she related to patients after her so-called “prosecution” and how they differed from her prior responses. She found herself ordering very extensive batteries of tests that she knew were unlikely to uncover the true diagnosis. In one example, her patient presented with the classic signs of “panic disorder” – episodes of heart palpitations, choking sensations, and shortness of breath that interfered with her work and home life. Dr. Kannai recognized the signs and symptoms and knew the specific treatments for the disorder. Nonetheless, because of her fear of missing a diagnosis or at least of not demonstrating that she had considered a range of potential diagnoses, Dr. Kannai went along with subjecting this patient to a wide range of tests with complete work-ups by a neurologist, cardiologist and gastroenterologist.
Her behavior, she felt, did not meet her idea of a “good doctor.” In addition, her patient was suffering because of her own defensiveness. Using her capacity for self-observation, which she described as her “inner dialogue”, she journeyed back, with some professional help, toward paying attention to her true self. Her article teases out the path of that journey and the steps she took to overcome her fears. Being “psychologically minded” enabled her to take the hard steps toward restoring her feelings of competence and comfort. She acknowledges she may be sued again but, in the meantime, she feels she is once again a competent physician who treasures not only her own feelings but the feelings and best interests of her patient.
