Emotional Detachment vs Emotional Engagement

Another tool for better mental health is emotional detachment, which enables physicians to maintain medical objectivity when handling stressful situations, particularly where attachment may affect clinical judgment. Such a situation may arise when providing care for terminally ill patients who continue to experience pain without hope of improvement. Treating family members is another situation where overattachment can be emotionally draining for physicians, which is why the American Medical Association Code of Medical Ethics advises physicians to avoid treating immediate family members.5

Detachment is difficult to maintain in the clinical setting because physicians encounter different situations that can elicit a range of emotions. For example, delivering bad news to a patient may cause emotions such as guilt, sorrow, distress, and even feelings of failure. Engaging with a difficult patient may evoke anger, frustration, and feelings of being unappreciated. In such situations, physicians may struggle to find a balance between empathy and detachment.

Clinicians at Boston Children’s Hospital were surveyed to determine how emotions influence their delivery of care.6 The majority (61%) of participants admitted that emotions such as empathy and anxiety may affect the care they provide. Empathy can help clinicians to better understand a patient’s perspective; however, when physicians over-identify with patients, the impact can become negative — for both the patient and physician.

According to Dr Teoh, “The challenge is to create psychological boundaries that separate the doctor from their work. I’m not saying doctors should depersonalize or detach from their patients when they are interacting or dealing with them. It is after that, when moving on to other tasks or when they are off work and need to switch off. It’s about having healthy work and home boundaries that you respect.”

Taking Care of the Healers

Self-compassion and detachment are crucial factors for the maintenance of physicians’ mental health. It is also important to maintain a balanced perspective; although detachment may help with maintaining objectivity in clinical practice, suppressing emotions may cause distress and burnout. Physicians must practice self-compassion and take good care of their own health and well-being so that they can better care for others. Self-compassion can be learned through various interventions that promote practices such as mindfulness, emotional regulation, and resilience. On a larger scale, it is ideal for self-compassion to be promoted in medical training.

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References

  1. Kerasidou A, Horn R. Making space for empathy: supporting doctors in the emotional labour of clinical care.BMC Med Ethics. 2016;17:8.
  2. van Wietmarschen H, Tjaden B, van Vilet M, Battjes-Fries M, Jong M. Effects of mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians: a mixed methods study.BJGP Open. 2018;2(4):16-21.
  3. Pakenham KI. Training in acceptance and commitment therapy fosters self-care in clinical psychology trainees. Clin Psychologist. 2017;21(3)186-194.
  4. Feingold JH. Toward a positive medicine: healing our healers, from burnout to flourishing. Master of Applied Positive Psychology (MAPP) Capstone Projects. 206;107:1-176.
  5. AMA Code of Medical Ethics. Treating Self or Family. https://www.ama-assn.org/delivering-care/ethics/treating-self-or-family. Accessed February 22, 2019.
  6. Martin EB Jr., Mazzola NM, Brandano J, Luff D, Zurakowski D, Meyer EC. Clinicians’ recognition and management of emotions during difficult healthcare conversations. Patient Educ Couns. 2015;98(10):1248-1254.

This article originally appeared on Medical Bag