There's No Crying in Medicine or is There?

When Dean Richardson, Barbaro's doctor, had difficulty keeping his composure when he spoke about Barbaro in the immediate aftermath (and actually sometimes even now) of the horse's death, did that make you feel any differently toward him as a professional? In other words, when a doctor cries either in front of a patient or, as Richardson did, when speaking about the patient, does this help or hurt his/her professional image?

It is an interesting question and one we have been pondering a bit in my class this semester. On Tuesday, Barron H. Lerner, M. D., a professor of medicine and public health at Columbia Medical Center and a fairly well-known scholar in the bioethics world, tackled the subject in The New York Times in an article entitled, "At Bedside, Stay Stoic or Display Emotions?"

As Lerner explains, the recent trend for doctors to display any type of emotion is a sharp departure from the centuries old stoic, detached stance practiced by most doctors of a certain age. The detachment, which often feels cold and uncaring to the patient, is, of course, a defense mechanism to guard against physician burnout. The theory is that avoiding emotional attachment to patients and their cases prolongs one's medical career.

As legions of patient illness narratives have documented, the cold bedside manner does little to improve patient morale. Not that every patient wants their doctor to hold their hands; more that every patient wants to know that there is a person in that white coat, not just a practitioner. Now, according to Lerner, most medical schools teach "physician-patient relationships and breaking bad news" (scary to think they actually have to teach compassion) but the real question still remains where to draw the boundaries.

In my class, the consensus, even among the med students, is that there is a time and a place to be emotional and it may not be at the patient's bedside. Many spoke of the need to keep their emotions in check until they could find a quiet place to cry, usually in the bathroom or even the broom closet. Lerner seems to be on the same page. "Whether because of my personality or my being a man, I, too, have never cried in front of a patient," he writes.

Which is probably a shame. I would argue that the danger of physician burnout caused by emotional attachment to one's patients, is equal to the danger of mental burnout caused by too much detachment from one's patients. The strain of keeping all those emotions in check has got to be as dangerous to one's health, physical and emotional, as letting it all hang out. There is still an aura of healer that we wish to associate with those who practice the profession and if we see them cry, this may mean they are not omnipotent or infallible as we would like to believe, especially about our own personal conditions. But not giving them permission to be human is doing those same practitioners more harm than good.

So, my guess is that Richardson cried for a lot of reasons--not the least of which was because he lost a patient he truly cared about--and that, in the end, it was good for his emotional health. My other guess is that we give our veterinarians a lot more leeway with regard to displaying their emotions than we give our human docs and that is not necessarily a good thing. Certainly each doctor has to do what is right for him/her and certainly all cases are different, but I don't think I would ever think less of a professional if I saw him/her shedding a tear.