“What Doctors Feel” by Danielle Ofri – 9 Important Take-Aways

Before you step FOOT into medical school, you must read What Doctors Feel by Dr. Danielle Ofri. Dr. Ofri is an essayist and internist. She has written 8 books, What Doctors Feel, her 7th. Recently, she released another book, When We Do Harm. She is heavily decorated with writing awards and recognized as one of the most pivotal voices in medicine.

Constantly presenting and talking about deconstructing perfectionism in medicine, she is a reminder that doctors are humans. Humans make mistakes and have feelings. Having an MD or a DO behind your name doesn’t change that.

The idea of perfectionism is something that most aspiring doctors strive towards from the moment they decide to pursue medicine. When you are taking classes, you feel this pressure that your grades have to be perfect. When you’re preparing for the MCAT, you feel like your score has to be perfect. Everything about your application needs to be “perfect” just to get in. Then after you get in, that pressure continues all the way through school so you get into your dream residency. Then during your residency, you still feel the need to be perfect to get a job and after that, you want a high patient rating so again, you must be perfect. It never ends The problem with this thought process, is it allows little room for error.

When medical students and professionals do fail, they deal with their failure in various ways. Reading What Doctors Feel as you pursue medicine will help you deal with your inevitable failures and all the other emotions you’ll feel throughout your career. So here are 9 Lessons that you’ll learn by the end of this book that will serve you well before you even begin your medical studies.

Lesson #1 – Doctors feel shame

Shame is an emotion stemming from embarrassment. We feel shame in our everyday lives from simple things; getting caught in the car singing by strangers, tripping over lines on the floor, etc. However, compared to the shame doctors feel after one of their errors, our everyday embarrassment pales. Medical errors can be life threatening, so there is very little room for error. The smallest mistake can have the most drastic effects.

In What Doctors Feel, Dr. Ofri laments on two stories. The first is personal; one where she almost killed a patient from a simple mistake. She didn’t even realize it was a mistake until her patient almost coded. The senior resident reamed her for her mistake, in front of her intern, causing her the utmost humiliation. And this moment of humiliation didn’t just come and go. It lingered with her for weeks as she racked her brain about how she could have possibly made that mistake.

Her second story is about a fellow that she worked under as a medical student. He made a switch up that cost a woman her life. His head hung for the rest of his fellowship and he never seemed to get over the guilt he felt. This entire chapter analyzes the guilt and shame that medical students and professionals feel. In addition to acknowledging that it’s a very normal emotion, she also draws attention to the fact that it happens. We’re human and there’s a way to handle it. Dr. Ofri lays out very effective ways to deal with this feeling and recover from even the most heinous of errors.

Lesson #2 – Doctors feel joy

Everything about medicine is not bad. In fact, if you’re good at your job, then you’ll experience more joy than any other negative emotion. Joy comes from even the smallest of victories like doing well on an exam. My most joyful experience of my medical school journey was getting into medical school. And that’s literally, just the beginning. As I journey through my career, I will experience joy that will come from my interaction with patients. Arguably, this is the best part of medicine.

Dr. Ofri shares some of her success stories, detailing her patients that had good outcomes. After hitting on some heavy, or maybe depressing topics, reading about her patients that have recovered, or lived longer than they were originally predicted, will make you smile as you read their stories. However, one important thing to take from the book is that as joyful as you may feel, you still have to stay grounded. Joy can be taken away just as quickly as it came. So, be happy and soak up the moment, but don’t get so carried away that IF you’re punched in the chest by something unexpected, the fall will be too much to bear.

Lesson #3 – Doctors lose confidence

Shiny white coats, brilliant smiles, and random bits of knowledge make doctors seem like the most confident people on the Earth. My guilty pleasure is Botched, the plastic surgery TV show where people get their messed up surgery fixed. Watching Dr. Teddy Dubrow and Dr. Paul Nassif amazes me because they are so confident in their skills. I mean you have to be to get impossible cases and feel very good about your chances to fix them.

But what happens when someone comes through and wrecks that confidence? Who’s the main culprit of kicking Drs.’ confidence around besides death? Those good ole’ lawsuits. Malpractice lawsuits are more common than not, but still doctors are shocked when they get them. Dr. Ofri goes into the ins and outs of When Doctors Get Sued and what it does to them. Having this knowledge and the expectation of getting sued helps reduce the betrayal and reduction in confidence.

She also talks about how not to get caught up in your relationships with patients and how well you think your rapport with them is. Be practical and expect that even your best patients may turn and sue you for any reason. The biggest thing to remember is to not forget who you are because of a lawsuit. As long as you are always trying to do things the right way and don’t get lazy, then you’ll have nothing to worry about. The law will be on your side and at the end of the day, this is what malpractice insurance is for.

Lesson #4 – Doctors become apathetic

It used to be the culture that doctors should carry on as unemotional as possible. This is referred to as aequanantimus, written by Sir William Olser, the father of modern medicine. Doctors were trained to be as far away from the patient, emotionally, as possible. This would keep doctors from getting too close to their patients and clouding their judgements. However, the problem with this approach is it creates the opposite effect. Doctors almost become too distant from their patients. This lack of empathy is a problem because it leads to misdiagnosis and ignored symptomatology.

Dr. Ofri spends many parts of the book discussing how doctors become unempathetic beings. Doctors, residents, medical students and everyone else fall into the culture of insensitivity. Hospital culture and fitting in are important to premedical and medical students. Therefore, we are more likely to laugh at inappropriate jokes and less likely to call someone out for saying something insensitive. As people at the bottom of the totem pole, we want to be liked. We are trying to impress people who could be letter writers or future bosses. Unfortunately, at the same time we train ourselves to become insensitive and dismissive. Read the different ways to avoid this in What Doctors Feel.

Lesson #5 – All patients matter

After working in a mental health hospital and as a teacher, there are a couple of common experiences between the two. One that is mentioned in this book is the hierarchy of patients and students. Meaning, some patients and students matter more than others. The idea that some patients and students matter less because they don’t put in effort or because they are self-sabotagers is very common. As a tech, there were plenty of patients that came in every few weeks because of their own bad behavior. Unfortunately because of low staffing and low patience, these patients don’t get the same attention and empathy that they did the first time around.

This issue even carries over to the emergency department. Dr. Ofri worked in the emergency room at Bellevue Hospital in New York City. She saw a lot of drug users and repeat offenders. Unfortunately, the overwhelmed staff who had developed extreme apathy to these types of patients wrote them off. As mentioned above, this lack of sympathy led to some patients being declined proper treatment. But as a doctor, you take an oath to treat everybody, regardless of their recreational activities. Find some tips on how to avoid falling into this trap from Dr. Ofri.

Lesson #6 – Emotions Cannot be Repressed

Have you ever been in a bad mood and the smallest thing sets you over the edge? You have let so many things slide over and over again. Then one day the smallest thing causes you to explode? Repressing emotions happens in everyday life, but it is an ugly monster in the medical world. Apathy builds up in doctors until one day, they just explode. All the emotions they didn’t let themselves feel just blow up in the most inopportune ways. However, before this explosion, repressed emotions manifest themselves in other ways. This can be a substance dependency, nasty attitude, shaken beliefs or the beginning of immoral behaviors.

This seems like a farfetched idea, but Dr. Ofri details the story of a friend who fell victim to repressed emotions. In full disclosure, she documents the beginning of her friend’s coping skills, all the way to the end of her dark spiral. These situations are real and can happen to anyone, especially those who think they have a lid on the situation. This story, among others in What Doctors Feel detail the risks of apathy and unfelt emotions. As humans, regardless of your profession, spiritually and mentally you cant afford to repress how you feel. It’s better to feel your emotions in real time and then bounce back from that setback.

Lesson #7 – Doctors aren’t perfect

Although I mentioned this at the beginning, I felt like it was worth another reminder. The idea of perfectionism has plagued the medical field forever. As schools are harder to get in and the competition just jumps up, you’ll feel this undeniable pressure to be completely perfect. But here’s the problem. with that, you aren’t perfect. I’m not saying don’t strive to try and be perfect. But accept that you aren’t and people practicing above you aren’t perfect. The same resident yelling at you has made more mistakes than they can even remember. The important lesson in making a mistake is learning a lesson from it.

The only wasted day is one in which you don’t learn something.

Darian’s Nuggets of Wisdom

Think about it, you should learn something new every day. Even when you’re not explicitly learning, you’re learning. Like I stated before, my 9 failed attempts at medical school were 9 lessons on what not to do. It’s definitely forced optimism, but helps you cope with mistakes. With mistakes comes shame and that shame can be crippling…if you let it be. However, if you claim the shame, then you can’t get beaten by it. This same sentiment is a common theme found throughout Dr. Ofri’s book.

Lesson #8 – Satisfaction in your job is a necessity

What is satisfaction? Satisfaction means feeling fulfilled by what you’re doing. If you go to work everyday and hate your job, then most likely you won’t feel a whole lot of satisfaction. But, if you choose a career that you really love, then you don’t have to worry about that. Life is short, the last thing you want to do is spend it doing something you absolutely hated. It’s not the 1970s anymore. You don’t have to force yourself into something because it pays the bills and that’s all that matters. Your happiness matters just as much.

Studies show that there is a link between job satisfaction and job performance. People perform better work when they are happy, so you need to find a job that makes you happy. Not only will you do better work (which could lead to less errors and potential bonuses) but you’ll be happier overall. If you spend 40+ hours a week doing something, then you better get some joy out of it. Dr. Ofri emphasizes this in her book about doctors finding satisfaction in their lives. As a doctor, it’s so easy to give so much of yourself that you start to resent your job. Find ways to continuously seek joy in what you’re doing to stay satisfied. Maybe even be like MJ and retire three times if that’s what it takes to keep your drive.

Lesson #9 – Patients must trust their physicians

What is a relationship without trust? It’s kind of like a house without a solid foundation. Without trust, your relationship has nothing to stand on. This is true in any type of relationship, especially a patient-doctor relationship. Patient compliance is a huge issue in the medical field. Doctors lay out very specific treatment plans, and for whatever reasons, patients don’t follow them. However the biggest issue with non-compliance, is patients’ concealment of their non-compliance. Non-compliance and secrets are all due to a lack of trust between the patient and physician.

When doctors pull back and distance themselves from patients to protect their feelings, patients feel this. This tension is the root of mistrust, reducing adherence to treatment plans. Dr. Ofri draws a connection between the lack of confidence and the reduced trust between patients and doctors. Doctors can’t let anything shake them up so much, that they let it affect how they relate to their patients. Building trust is the first thing you should do with your patients. The earlier you start practicing, the better.

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