REFLECTIONS
Are doctors allowed to cry at work?
Thirunavukkarasu Arun Babu
Published online first on June 2, 2023. DOI:10.20529/IJME.2023.036Abstract
This article recounts a poignant interaction between the author and a mother of a child with cerebral palsy. The mother’s remarkable strength and optimism in the face of adversity deeply moved the author, leading to a tearful moment which prompted a comforting response from the mother. The ongoing debate regarding whether doctors are allowed to display emotions in their professional lives centers around the challenge of balancing professionalism with the emotional impact of providing healthcare to patients. While doctors are expected to uphold professionalism and make sound decisions in their work environment, simultaneous expression of emotions, empathy, and vulnerabilities becomes inevitable.
Keywords: doctor-patient relationship, emotional intelligence, empathy, clinical decision-making
A mother in her mid-fifties recently brought her 14-year-old son with cerebral palsy for a follow-up visit to our outpatient department. She was carrying her fully grown adolescent boy in her arms when she entered my consultation room. They have visited me regularly for the last four years. The boy has spastic quadriparesis, microcephaly, and seizure disorder. The mother is a PhD scholar but had to give up her job to take care of her son. I have always remembered this mother as a cheerful, highly motivated, spirited person. Despite her child’s condition, I have never seen her dull or sad. During the consultation, she listened carefully to what I had to say and got her doubts clarified in a calm and composed manner. Her hope, passion and positivity moved me immensely. Even after knowing the poor prognosis and facing the inevitable, her grit, resilience and grace shook me. She was relentless, not ready to give up and had a fighting spirit symbolising motherhood universally. I empathised with her and couldn’t resist appreciating her for the great job she was doing. The harsh truth in my own words hit me hard and was emotionally overwhelming. Within seconds, I struggled, trying hard, but unsuccessfully, to hide my tears. I paused briefly, gasping to find words, as tears rolled down my cheeks. The mother had already noticed my reaction even before I could recover. There was an awkward silence in the room for a moment. Her stoic stare slowly transformed into a gentle, comforting smile. I breathed a huge sigh of relief. She thanked me and left with her son soon after that. This episode left me hugely embarrassed. Though, as doctors, we try hard to project ourselves as perfect professionals, our core instincts and humanity sometimes take over.
I have always wondered whether doctors are even allowed to cry in front of patients. Crying in clinical settings though common, especially while breaking bad news or dealing with death, is an under-reported and understudied phenomenon [1,2], and a complex and multifaceted issue. On the one hand, doctors are expected to remain composed and professional in the face of difficult and emotional situations. On the other, they are human beings with emotions and vulnerabilities, and their work can be incredibly challenging and emotionally draining.
There are several arguments in favour of doctors being allowed to cry in their professional life. First and foremost, doctors are not immune to the emotions that come with caring for patients. They witness the pain and suffering of their patients and their families on a daily basis, and it is only natural that this can take an emotional toll on them. Therefore, expressing their emotions, even crying, can be a healthy and necessary way for them to cope with the stresses of their work [1].
Furthermore, crying can be a powerful way for doctors to connect with their patients and demonstrate empathy. Patients and their families often appreciate a doctor who is willing to share and thus validate their emotions [1, 3]. By allowing doctors to cry, we can improve the doctor-patient relationship and ultimately improve the quality of care that patients receive.
However, there are also arguments against doctors crying in their professional life. Doctors are expected to maintain a level of professionalism and control in their interactions with patients. Crying may be seen as a sign of weakness or lack of professionalism, which could erode the trust and confidence that patients have in their doctors [2, 3].
Additionally, doctors who cry may be perceived as being too emotionally invested in their patients, which could cloud their judgement and lead to poor decision-making [3]. In some cases, doctors may need to make difficult and emotionally charged decisions, such as whether to continue aggressive treatment for a patient who is unlikely to recover. If a doctor is too emotionally involved, they may not be able to make the best decision for their patient. However, it is important to recognise that doctors are human beings with emotions, and it is unrealistic to expect them never to show any vulnerability or weakness.
Instead of asking whether doctors should cry at work, perhaps the more important question is how we can support them in coping with the emotional demands of their work. This could include providing access to mental health resources, offering opportunities for self-care and reflection, and creating a culture that values emotional intelligence and empathy.
In conclusion, the debate over whether doctors should cry in their professional life is a complex and nuanced one. In the medical field, crying has traditionally been considered unprofessional. There is a constant urge for physicians to always portray themselves as strong, calm and dependable and not an “emotional mess”. Crying is a basic human reaction and a sign of empathy. It is acceptable to cry occasionally, especially when it is in the patient’s interest. There is no need to be hard on oneself. Unprocessed emotions are dangerous for human health. Though detachment is essential for clinicians for sound decision-making, over-detachment can lead to emotional neglect and denial, which can have adverse consequences. Expressing emotions such as empathy, shedding a few tears or, in extreme cases, crying out loud, doesn’t make any doctor weak, bad, or unprofessional. All doctors are, after all, humans first!
Conflict of interest and funding: None to be declared.
References
- Pruthi S, Goel A. Doctors do cry. Indian J Med Ethics. 2014 Oct-Dec;11(4):249-51. https://doi.org/10.20529/IJME.2014.063
- Robinson F. Should doctors cry at work? BMJ. 2019 Feb 26;364: l690. https://doi.org/10.1136/bmj.l690
- Janssens KME, Sweerts C, Vingerhoets AJJM. The Physician’s Tears: Experiences and Attitudes of Crying Among Physicians and Medical Interns. J Clin Psychol Med Settings. 2019 Dec;26(4):411-420. https://doi.org/10.1007%2Fs10880-019-09611-9
Dr. Thirunavukkarasu Arun Babu has written a very important and interesting reflection titled “Are doctors allowed to cry at work?” published in the Indian Journal of Medical Ethics Online First on 02 June 2023.[1] Reading this reflection opened several memories of situations where I have struggled with my emotions while caring for patients. I have engaged with this exact question in the past and this reflection gave me more food for thought. I am glad to write a brief response to this reflection, where in addition to agreeing with his point of view, I also want to share my thoughts on restoring the human element in a rapidly professionalizing, mechanizing and depersonalizing field, medicine.
When I was doing my residency training in community medicine, I provided care for a 26-year-old woman, who was pregnant for the fifth time, with no live children. She had lost all her children either during delivery or immediately following birth. Selvi (name changed) had what we call ‘bad obstetric history’ and needed expert care. This time, we had done everything right. We admitted her in the antenatal ward at 30 weeks, with more than 2 months left for the delivery. Selvi was a constant presence in the ward. She, her husband, and I became good friends over the two months that she was in our ward. We would even go out to the teashop just outside the hospital and have a light conversation over a hot cup of tea. Whenever her husband brought some goodies for her to eat from home, there would always be some saved for me. At around 39 weeks of her pregnancy, Selvi went into labor and delivered a girl child weighing 3 Kg. But the baby struggled to breathe on her own and after a lot of efforts in resuscitating her, she died within 4 hours of birth. I remember holding Selvi, right there in the labor ward and crying with her. Later that evening, my senior colleague took me out for dinner and gave me advice on how I should be a solid rock of support for Selvi and cannot be emotionally weak and vulnerable. Her words sent me through a lot of confusion and self-doubt. While holding her and crying with her seemed like the most natural thing to do at that moment, I was wondering whether Selvi felt that my crying was inappropriate or weak. After establishing such a close and personal bond with a patient, I felt that it would seem extremely unnatural to act as though the death of the newborn did not affect me deeply. Whenever, I have an ethical dilemma, my go-to strategy is to think of how my mentor Dr. K.P. Misra, would handle such a situation. I remembered a situation in which my mentor took me with him to attend the funeral of a long-term patient of his and shared the grief with the bereaved family. I saw and learned from that situation that medicine is a very human enterprise which is often emotionally charged. It is unnatural to remain stoic during emotional moments while caring for patients. Selvi’s episode gave me the conviction and confidence that being human, showing empathy and sharing pain are far more important than artificial professional standards.
In fact, I think being emotionally intelligent is thorough professionalism. An emotionally intelligent doctor knows the appropriate way to express her emotions.[2] She understands the emotional context in the clinical encounter and judges what is the appropriate emotion to express in that context. Remaining cold during an emotionally charged situation can erode trust in the doctor-patient relationship as much as breaking down and crying when it is not appropriate. Crying along with the patient in an emotional moment does not mean the doctor is not supporting the patient. Crying along with them may help them perceive greater support and understanding, than a set of emotion-free cold words of comfort. Emotional engagement helps serve the patient with more care and diligence than detachment.[3]
We provide non communicable disease care on a voluntary basis, for the rural poor near Chengalpet through the NGO, Rural Women’s Social Education Centre (RUWSEC). The ethos of the clinic and all the care providers who work there is kind, compassionate, empathetic care with the limited resources that we have there. Many times, all that we have to offer in the clinic is empathetic listening and kind words of comfort. The clinic is extremely popular in the surrounding areas because of the emotional intelligence that is exercised there by all the staff. There are regular patients, who just come there to talk to us, share their feelings, have a heartfelt cry, sometimes along with us, and feel light-hearted and return to their difficult lives. We believe that we are contributing in our own small way by being human, and by allowing our emotions to flow freely. Our patients give us feedback that they feel comfortable and relaxed to be in our presence. There is probably something for all health care providers to reflect on from this model.
Medicine is rapidly professionalizing, mechanizing and depersonalizing. Some of our patients tell us sad stories of how doctors barely look them in their eyes. They only see the scans and laboratory reports. Touching the patient, examining, using the stethoscope to listen to their chests, have all become rare acts within the clinic. So, when they come to us and experience the empathetic listening, the ritual of thorough physical examination and the detailed explanation for each condition and treatment, they feel refreshed and want to come back to us, even though we are highly resource deprived and have very little specialized care to offer them. I take this opportunity to emphasize the importance of restoring all these human elements in medicine. Rather than looking at ‘crying at work’ as an unprofessional act, I request us to look at expression of appropriate emotions as thorough professionalism. Being empathetic and mirroring our patients’ emotions, is essential for gaining a good understanding of what the patient is going through and how we can help them. Empathizing and understanding their feelings does put the health care provider in a position of vulnerability. But this vulnerability is essential for providing good quality medical care. True strength is in accepting and handling the emotional vulnerability.
References:
1. Babu T.A. Are doctors allowed to cry at work? Ind J Med Ethics 2023. Available at: https://ijme.in/articles/are-doctors-allowed-to-cry-at-work/ Accessed on: 06 Jun 2023. https://doi.org/10.20529/IJME.2023.036
2. Birks YF, Watt IS. Emotional intelligence and patient-centred care. J R Soc Med. 2007 Aug;100(8):368-74. https://doi.org/10.1258%2Fjrsm.100.8.368
3. Sundararajan, S., Gopichandran, V. Emotional intelligence among medical students: a mixed methods study from Chennai, India. BMC Med Educ 18, 97 (2018). https://doi.org/10.1186/s12909-018-1213-3
Drs. Thirunavukkarasu Arun Babu and Vijayaprasad Gopichandran have provided a much needed correction to the traditional view that doctors should not display emotion in front of the patient.
As both of them have correctly emphasised, there will be events where the physician is overwhelmed by emotion. To expect the physician to suppress true feeling and show a mask-like face is inhuman.
I am certain that under the right circumstances, patients and families are appreciative of such a display of the innermost feeling by the physician. The bond between physician, patient and family is strengthened and this can only do good for all of them.
Respected Sir,
I agree with what you have commented. In my clinical practice as a physiotherapist, we spend more time with a patient wherein they share their personal issues and what they are going through. Feeling or Empathising what the patient feels has always helped to think better for the patient during care provision and service delivery. Often we encounter parents of children with cerebral palsy who keeps asking when my child will be okay? There were many emotional moments wherein they even feel that they have committed a sin which has led to their situation wherein their children are affected. Leaving aside Karma and other related philosophies, and as a human care provider, I feel there is a no harm in going through the emotions of what the patient feels. It actually helps to build more rapport. One of my geriatric patient suffering from bed sores due to immobility was a fan of an actor and was eager to listen his songs. He was isolated from his family. Whenever I used to visit him for the therapy, he speaks with tears about his loneliness and I barely noticed tears in my eyes. I felt bad that I couldn’t help him on that. The next day, I download some of his favourite hero’s songs and played them during the therapy with his permission. He felt so energized and cooperated like never before. It became a fun filled session for him. He thanked me with his heart and tears in his eyes. At emotional moments, if it is going to help the patient mentally or physically, there is no harm is taking their emotions with us. Being gentle is actually being strong!
I recalled an interesting observation on the subject. This was made many years ago by Mr Anatole Broyard. He had served as an editor of the New York Times Book Review and suffered cancer of the prostate with metastases. He died from this disease. Discussing what he would expect from his doctor, he stated:
‘Physicians are commonly cautioned against being emotionally involved with their patient.’ Mr Broyard disagreed. Bemoaning the fact that most physicians do not delve into the inner being of the patient, he stated, ‘I would like to think of him as going through my character, as he goes through my flesh, to get at my illness, for each man is ill in his own way. Proust complained that his physician did not allow for his having read Shakespeare…A doctor’s job would be so much more interesting and satisfying if he would occasionally let himself plunge into the patient if he could lose his own fear of falling…Every patient invites the doctor to combine the role of the priest, the philosopher, the poet, the scholar. He expects the doctor to evaluate his entire life, like a biographer.’