Preface

Whether painful or joyous, threatening or uplifting, emotions are a constant in the work life of healthcare providers. The provider’s emotional experiences, the patient’s emotional experiences, and how they handle them are the dual, and intersecting, subject of this book. By combining evidence from research on emotion with the insights of experienced clinicians and medical educators, we aim to add much-needed guidance for both learners and teachers around this crucial aspect of clinical professionalism.

The idea for this book came after one of us conducted three emotion workshops among practicing clinicians, trainees, and medical educators at Stanford University. Feedback from these workshops suggested that this content was largely missing from current medical training, and participants were eager for additional evidence-based resources that could guide them in how to navigate their own and their patients’ emotions more skillfully. The first workshop was on the physiological, social, and clinical function of emotion, the second was on the relationship between emotional expression and culture, gender, and specific patient populations, and the third was an interactive panel consisting of four physicians from different specialties who shared what training they did (and more notably, did not) receive in navigating emotion, and how they had handled particularly challenging patient encounters. They shared stories about situations in which their own emotional response—or lack thereof— had affected the clinician–patient relationship, and what systems-level changes they felt were necessary to support more successful clinician–patient interactions. Attendees saw the panel session as the most valuable due to how rare it is for clinicians to learn from peers about what is usually a very private endeavor. The panelists embodied the change they advocated for: namely, the need for more opportunities to talk with peers in a nonthreatening setting about challenging patient encounters, and to learn new strategies for working with patients and managing one’s own reactions.

The ultimate impact of honoring, and normalizing, the emotional demands of practicing medicine has yet to be seen, though we had a hint at what it might look like at the panel. One of the panelists spoke candidly about her experience realizing she had become numb over the course of her clinical practice. She spoke of how she had learned the word “alexithymia” at a physician wellness lecture, realized she had it, and decided to seek help. After the panel, one of the younger physicians in the audience took her aside and said, “Can you tell me that word again? I think I may have it…” It may take having more senior clinician leaders bravely acknowledge the emotional costs they’ve paid as part of their commitment to caring for others before the next generation of clinicians can become more fully equipped with the tools necessary to engage with emotion—their own, and that of their patients.

Emotions are ever-present in the context of illness and in the process of medical care and have an enormous impact on the well-being of patients and healthcare providers alike. However, this topic is acknowledged and taught in an inconsistent manner in medical education, and the research that should inform clinical management of emotion is scattered. In this book, we present theory and research on the broad topic of emotions in medical care, providing both basic understanding and practical insights on one of the most vital yet challenging aspects of patient care: recognizing and responding effectively to the patient’s emotions as well as healthcare providers themselves recognizing and tending to their own emotions.

Healthcare providers often understand that emotions are important in the process and outcomes of care, yet frequently report feeling ill-equipped to handle their own and their patients’ emotions effectively. Despite clear evidence that clinicians’ responses to patients’ affective cues are linked to care outcomes, instruction on how to effectively identify and manage emotion in a clinical interaction is not a systematic part of medical education curricula. While high rates of burnout, characterized by emotional exhaustion, depersonalization, and the loss of a sense of personal accomplishment, are reported for medical trainees and practicing providers, there is evidence that emotional intelligence and emotional stability may be protective against burnout. This book seeks to advance healthcare providers’ knowledge of the science of emotion while providing evidence-based guidance on how to apply these principles in clinical practice. New curricular content is provided to offer pathways for developing the skill set necessary to navigate the extraordinary emotional demands of practicing medicine.

This book is organized in three sections: Emotion’s Functions, Clinical Emotional Intelligence, and Emotions in the Culture of Medicine.

Emotion’s Functions

The introductory chapter, Emotions in 21st-Century Humanistic Medicine, provides an overview of why emotions are important for patient outcomes, clinician wellness, and the clinician–patient relationship. Other chapters in the Emotion’s Functions section provide transdisciplinary background on the evolutionary, neurobiological, and social function of emotion, the role of emotion in illness, and emotional dialogue in the medical encounter.

Clinical Emotional Intelligence

The Clinical Emotional Intelligence section covers the importance of identifying patients’ emotional cues and provides evidence on the role this plays in the clinician–patient relationship and in clinical outcomes. This section contains chapters on nonverbal cues of emotion, strategies for emotion recognition, the role of emotion in clinical decision making, and available training tools for honing these practices. Other chapters address emotion regulation techniques, and the intersectional relationship between patient and provider background (including gender, nationality, and race/ethnicity), emotional displays, and associated bidirectional expectations and biases that shape clinical interactions and subsequent outcomes. Three chapters are devoted to specific patient populations: pediatric patient encounters, patient populations with impaired affect, and patients with a history of trauma.

Emotions in the Culture of Medicine

The Emotions in the Culture of Medicine section addresses the professional challenges of honoring emotion in a medical culture that praises stoicism and analytical reasoning. One chapter provides strategies for teaching about emotions in healthcare, another describes interventions that can promote emotional wellness in undergraduate and graduate medical trainees, and the concluding chapter focuses on the relationship between emotion and clinician wellness.

Taken together, this volume synthesizes concrete, actionable steps that can be taken to enhance emotional training for the well-being of clinicians and patients alike. We draw on an international cadre of experts in clinician–patient communication, clinician wellness, emotion research, and medical education. We specifically selected authors from across diverse medical specialties, research specialties, and professional perspectives outside of medicine (social psychology, clinical psychology, education, bioethics, occupational therapy, counseling, and public health) to produce a book that provides guidance for all clinicians, trainees, and medical educators, regardless of specialty, degree, or patient population. It is our hope that readers will come away with a new understanding of the importance of effective clinical management of emotion for patient and clinician wellness, new techniques for teaching emotion regulation and clinical communication strategies, an appreciation of the need for new medical education practices to support the role of emotion in the clinical encounter, and tools for beginning to effect the cultural changes necessary to honor emotions in clinical settings.