How doctors feel: affective issues in patients' safety

Department of Emergency Medicine and Department of Medical Education, Dalhousie University, Halifax, NS, Canada B3H 2Y9.
The Lancet (Impact Factor: 45.22). 11/2008; 372(9645):1205-6. DOI: 10.1016/S0140-6736(08)61500-7
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Available from: Allan Abbass, Jun 10, 2014
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    • "It is clear from these interviews that consultants experience consultations with patients with personality disorder as emotionally charged and that doctors sometimes prescribe to preserve a good doctor-patient relationship.29 Clinical guidelines do not adequately take into account the relational aspects of prescribing, leaving doctors struggling to follow prescribing guidance when under great pressure to do something.30 "
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    ABSTRACT: Aims and method To explore experiences of psychiatrists considering medication for patients with personality disorder by analysis of transcribed, semi-structured interviews with consultants. Results Themes show important relational processes in which not prescribing is expected to be experienced as uncaring rejection, and psychiatrists felt helpless and inadequate as doctors when unable to relieve symptoms by prescribing. Discontinuity in doctor-patient relationships compounds these problems. Clinical implications Problems arise from: (a) the psychopathology creating powerful relational effects in consultation; (b) the lack of effective treatments, both actual and secondary to under-resourcing and neglect of non-pharmaceutical interventions; and (c) the professionally constructed role of psychiatrists prioritising healing and cure through provision of technological interventions for specific diagnoses. There is a need for more treatments and services for patients with personality disorder; more support and training for psychiatrists in the relational complexities of prescribing; and a rethink of the trend for psychiatrists to be seen primarily as prescribers.
    06/2014; 38(3):116-21. DOI:10.1192/pb.bp.113.044081
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    • "In addition, emotional processes are prerequisite to transferring knowledge and skills learned in school into novel situations and real-world decision making (Immordino-Yang and Damasio 2007). Being able to deal with emotions is considered a critical feature of medical students' and doctors' overall clinical performance, including diagnostic processes, medical decision making, and interpersonal relationships (Croskerry et al. 2008). Emotions have only recently attracted serious attention in the medical education literature . "
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    ABSTRACT: Dealing with emotions is a critical feature of professional behaviour. There are no comprehensive theoretical models, however, explaining how medical students learn about emotions. We aimed to explore factors affecting their emotions and how they learn to deal with emotions in themselves and others. During a first-year nursing attachment in hospitals and nursing homes, students wrote daily about their most impressive experiences, explicitly reporting what they felt, thought, and did. In a subsequent interview, they discussed those experiences in greater detail. Following a grounded theory approach, we conducted a constant comparative analysis, collecting and then interpreting data, and allowing the interpretation to inform subsequent data collection. Impressive experiences set up tensions, which gave rise to strong emotions. We identified four 'axes' along which tensions were experienced: 'idealism versus reality', 'critical distance versus adaptation', 'involvement versus detachment' and 'feeling versus displaying'. We found many factors, which influenced how respondents relieved those tensions. Their personal attributes and social relationships both inside and outside the medical community were important ones. Respondents' positions along the different dimensions, as determined by the balance between attributes and tensions, shaped their learning outcomes. Medical students' emotional development occurs through active participation in medical practice and having impressive experiences within relationships with patients and others on wards. Tensions along four dimensions give rise to strong emotions. Gaining insight into the many conditions that influence students' learning about emotions might support educators and supervisors in fostering medical students' emotional and professional development.
    Advances in Health Sciences Education 08/2013; 19(3). DOI:10.1007/s10459-013-9477-1 · 2.12 Impact Factor
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    • "First, regret may influence clinical decision-making. While the influence of cognitive processes on medical decisions has been extensively studied [4], [5], the impact of affective processes has as yet received little attention [6], [7]. Regret plays a key role in various types of decisions [8], [9], including medical decisions [10], [11], [12]. "
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    ABSTRACT: Regret is an unavoidable corollary of clinical practice. Physicians and nurses perform countless clinical decisions and actions, in a context characterised by time pressure, information overload, complexity and uncertainty. To explore feelings associated with regretted clinical decisions or interventions of hospital-based physicians and nurses and to examine how these regrets are coped with. Qualitative study of a volunteer sample of 12 physicians and 13 nurses from Swiss University Hospitals using semi-structured interviews and thematic analysis All interviewees reported at least one intense regret, which sometimes led to sleep problems, or taking sickness leave. Respondents also reported an accumulation effect of small and large regrets, which sometimes led to quitting one's unit or choosing another specialty. Respondents used diverse ways of coping with regrets, including changing their practices and seeking support from peers and family but also suppression of thoughts related to the situation and ruminations on the situation. Another coping strategy was acceptance of one's limits and of medicine's limits. Physicians reported that they avoided sharing with close colleagues because they felt they could lose their credibility. Since regret seems related to both positive and negative consequences, it is important to learn more about regret coping among healthcare providers and to determine whether training in coping strategies could help reduce negative consequences such as sleep problems, absenteeism, or turnover.
    PLoS ONE 08/2011; 6(8):e23138. DOI:10.1371/journal.pone.0023138 · 3.23 Impact Factor
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