Summary: Danielle Ofri, attending physician at Bellevue Hospital, co-founder and editor-in-chief of the Bellevue Literary Review and the author of What Doctors Feel: How Emotions Affect the Practice of Medicine (Beacon Press, 2013), makes the case that for the best patient care, the emotions of doctors should be explored and understood rather than kept in check. Excerpt: What Doctors Feel by Danielle Ofri, MD The Doctor Can’t See You Now Ethnic differences are but one example of cultural divides between doctors and patients. Another cultural divide—arguably far vaster—turns up in the context of illnesses that are perceived to be self-induced. Doctors have notorious contempt for alcoholics, drug addicts, and morbidly obese patients, and they often make little effort to conceal it. By unspoken rules, these patients are considered fair game for jokes by medical personnel at all levels. Hospital slang for such patients reflects not just disgust but also anger and resentment. It’s not uncommon to hear an obese patient referred to as a beached whale, or a homeless alcoholic called a shpoz or dirtbag. Physicians are the products of an educational system that demands years of self-discipline and delayed gratification. Despite the knowledge that addiction and obesity have at least some biological components, many doctors still unconsciously—and often consciously—view these conditions as purely a result of sloth, self-indulgence, greed, malingering, and apathy. Respect and appreciation for the ravages of these illnesses—especially when the patients themselves often appear not to—is more than some physicians can muster. There’s no doubt that patients with addictions are probably the most difficult type of patients to work with. Beyond the biologic components of their illnesses, these patients are often saddled with complex overlays of depression, childhood mistreatment, sexual abuse, socioeconomic ills, and personality disorders, not to mention a fragmented medical system with meager options for treating addiction. Whatever inroads a doctor, therapist, program, or the patient herself might make is handily inundated by the multitude of counterforces that seem to conspire against successful treatment. It’s no wonder that doctors-in-training rapidly assume a nihilist attitude toward addicts and invest as little as possible in their care. The residents and students that we train at Bellevue Hospital see so many alcohol (ETOH, or ethanol) withdrawal patients that these cases cease to have any individuality. If the admitting diagnosis is ETOH WD, the team typically takes a cursory history and then just dials up the benzodiazepines until the shakes subside. The days are counted until the patient can walk steadily and thus be discharged. Attempts at drug-rehabilitation referrals are halfhearted at best. Empathy is in short supply. It’s not hard to see why otherwise conscientious and empathic young doctors behave this way. The ETOH-WD patients are typically surly, smelly, and demanding. Nearly all of them march right out of the hospital to their next drink and then get readmitted two weeks later. Many of these patients sport records of multi-city tours of rehabs, all of which seem to have amounted to nothing. Quite a few are skilled manipulators for oxycodone and Valium. Many have managed to obtain public assistance or disability but appear to do nothing but drink or take drugs. It is easy for doctors—who usually approach life with a pull-yourself-up-by-your-own-bootstraps attitude—to become resentful and disgusted by these seemingly parasitic, self-serving moochers. John Carello was one such patient I took care of several years ago. The resident on my team announced our new admission by drily stating that this was Mr. Carello’s fifty-seventh admission to Bellevue Hospital. Every admission was for either overdose or withdrawal from opiates—heroin or oxycodone. Today was an overdose, and the official treatment plan consisted of letting Mr. C
