Friday, September 29, 2023

Helen Salisbury: The weight of emotions

Patients bring many things with them to the consulting room. Some we’re expecting, including their symptoms, thoughts, worries, and expectations; some are unexpected but a nice surprise—chocolates and biscuits, homemade jam, allotment produce—while others are less welcome. These include evidence of illness presented in a nappy or handkerchief, and occasional parasites that remain after the patient has departed (we had a recent problem with bedbugs, resulting in a stressed and itchy nurse and a clinical room out of action as it awaits a deep clean).

Patients also bring their grief, anger, frustration, and fear or sense of loss in varying measures. Some have spent a long time ricocheting around our dysfunctional health and care system, and for them we try to provide a calm place and a plan, or at the very least a space where they feel heard. I’m aware of my own privilege and good fortune as I listen to complex histories of domestic violence, alcohol misuse, or just the ordinary misery of pain, stress, financial hardship, or relationship breakdowns.

But what do we do with all the things patients bring to us? The biscuits belong by the kettle, and the excreta in the clinical waste bin, but the emotional load isn’t so easily laid down. We try to tease out the areas where we can offer something practical—advice, medicines, referrals—but we’re often left with a tangle of emotions and a sense of our own impotence in the face of a sad and unfair world. Not all patients will affect us equally, and some cases will strike a particular chord because an experience chimes in some way with our own, or because we’ve looked after a patient for many years and know not just them but their whole family.

In other professions that involve listening to people in distress, such as psychotherapy and counselling, supervision is mandatory. In those sessions the practitioner discusses both how they’re handling a case and the impact it’s having on them. Doctors, on the other hand, are generally expected just to get on with it, which can be lonely. Our specialist trainees have weekly tutorials that offer opportunities for unburdening, and some of them benefit from mentoring and peer support through the New to Practice fellowship scheme when they qualify.

But after these early years it can be a matter of luck: if you’re fortunate enough to work in a practice that has a close team and enough time to draw breath, coffee breaks may provide space for sharing and support—although this also requires adequate privacy and the confidence that no one is judging you. However, since many doctors will prioritise eating or going to the loo in the few minutes they have to spare in the working day, I suspect that many go home still carrying the weight of other people’s emotions, burdened by worries about their patients’ safety, and wondering if they could or should have done more.

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