The current state of medical education is woefully deficient in educating its learners about the role of emotions in healthcare. —Johanna Shapiro, 2013 (p. 314)1
Emotion is inseparable from medical care, yet its role in care delivery, healing, and the clinician experience is complex and often ignored and unaddressed by clinicians. This is in part due to how the culture of medicine has evolved; what began as a relational art has morphed into a more technical science with the rise of technology and the influence of medical forbearers who equated mastery of one’s emotion with medical competence and professionalism. Ambivalence about the role of emotions, the ever-shifting tension between too much and too little emotion and uncertainty about how to make use of emotion for good ends have all, we believe, contributed to the nearly complete lack of training in emotion regulation and management that many clinicians receive. In their 2007 systematic review of emotion skills training for medical students, Satterfield and Hughes2 concluded:
[T]here is currently no operational definition of the superordinate construct of emotion skills in medicine, nor is there a complete developmental theory regarding the teaching and acquisition of emotion skills in medical providers. None of the studies reviewed provided a framework for understanding emotion skills development nor a discussion of how emotion skills are manifested in other areas of clinical care. (p. 939)
Despite increasing scholarship and interest in empathy and emotional socialization within the medical field,3 scholars and medical educators have much work ahead to address this gap.
Emotions are ever-present and consequential in a clinical encounter, and their importance cannot be overstated. There are three crucial, and interlocking, reasons why we say this,4 which we call the Three Principles. Although these principles may seem obvious, taking them seriously has far-reaching implications. They are the basis for everything that follows in this book.
Principle 1: Both Clinicians and Patients have Emotions
Some of these emotions precede the visit and have nothing directly to do with the visit itself. The clinician might be irritable due to fatigue, worried about finances, or anxious about their competence (we will often refer interchangeably to physicians, providers, clinicians, and healthcare providers). Clinicians are not professional robots who enact a scripted role; they are people with their own issues, styles, and habits, and, consequently, the full range of emotions, both pleasant and unpleasant. Likewise, patients have their own sources of emotional experience related to work, family, society, and their health. For both parties, these emotions can have profound effects on their mental and physical well-being. Furthermore, these emotions do not vanish at the door of the examining room; they impact the transaction in both subtle and extreme ways and their impact is often outside of awareness and unacknowledged.