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On the Brain
DZ𳾲4, 2024

Remembering the Physician’s Humanity—Physicians Are Humans Too

Author Affiliations
  • 1Department of Neurology, University of California, San Francisco
JAMA Neurol. Published online November 4, 2024. doi:10.1001/jamaneurol.2024.3744

The angry voice of the patient’s partner bellowed at me. The frustration boiled over and they rapidly fired words at me. This was not because of my actions; rather, it was a response to our health care system. I understood where they were coming from—their beloved was suffering without a clear path to respite. I imagine I would feel similarly if my husband were in the same situation. But in the moment, it was difficult and hurtful to experience. I had been working diligently to diagnose and treat their loved one’s condition. Relationship-centered communication with PEARL (partnership, empathy, acknowledgment, respect, legitimization) statements did not diffuse the situation. I had to set a boundary, so I gathered my resolve and said that I was feeling attacked.

In this moment, despite my compassion and empathy for their situation, I could not and would not take any further belittlement. Immediately they backtracked and said they were not attacking me but the situation. I acknowledged how tough the situation was and encouraged us to work together as partners to investigate and manage the situation. They agreed, and we continued the appointment in a productive way.

Boundaries are necessary for all relationships, and sometimes physicians need to be brave enough to set them with patients. Interpersonal relationships refer to reciprocal social and emotional interactions between the patient and other persons in the environment.1 The physician-patient relationship is a unique interpersonal relationship that has multilayered dimensions. Historically, physician-patient relationships have been 1-sided, but recent years have seen the emergence of collaborative and patient-centered care. While this generally leads to better care, I, as a multiracial African American and Japanese female neurologist, have experienced many patient-initiated interactions that negatively impact me. Sometimes a patient can make statements that tax me emotionally. Comments like “Your hair is nappy” or “You’re the doctor?” (said in disbelief), or other comments about my appearance, weigh on me. I can now identify these as microaggressions, which are everyday verbal, nonverbal, or environmental slights, snubs, or insults, whether intentional or unintentional, that communicate hostile, derogatory, or negative messages to target persons based solely on their marginalized group membership.2

Microaggressions happen frequently and accumulate over time, like tiny cuts. As a human being, I have an emotional response to these. But, for patient care, I am expected to ignore those emotions and care for others like a well-tuned robot. I am required to lock my feelings away and proceed like they do not exist. Healthy? I think not. I am honored to care for patients and realize it is a privilege to promote individual health. However, I have come to the point where I also must balance my own emotional and physical health and well-being.

I realize some of my attitude may be consistent with burnout. Burnout is a state of mental exhaustion, depersonalization, and a decreased sense of personal accomplishment.3 Since the COVID-19 pandemic, physical and mental burnout has increased dramatically. Rates of burnout symptoms have been associated with adverse effects on patients, the health care workforce, costs, and physician health. Burnout symptom rates exceed 50% in studies of both physicians-in-training and practicing physicians.4 Emotional exhaustion describes what I experience at times, and it is a major component of physician burnout.3 I would argue that my emotional exhaustion is different than, say, a White male physician’s potential burnout etiology. As an African American woman in the United States, the microaggressions I experience on a routine basis greatly contribute to this emotional exhaustion. LaFaver et al5 reported higher rates of burnout in women, and being underrepresented in medicine also is associated with higher rates of burnout.6,7 Burnout impacts groups differently, and while our health system is now beginning to support building skills for well-being in training and in practice, for many decades burnout was ignored.

In the era before the pandemic, it was commonly accepted that physicians push through and work when sick. I came to work sick because I felt remorseful about canceling on patients the same day who were driving quite a distance to see me and had waited longer than 3 months (more like 6-12 months) for this neurologic evaluation. I wore a mask and practiced good hand hygiene while I pushed through my clinic day. Although my malaise was heavy and my fatigue was increasing, I was proud that I was considerate of the patients and provided care—until I received a low patient rating and a comment complaining that I came to work sick.

What?!?!

First, shock ran through my system, quickly followed by devastation. After I forced myself to work for the consideration of the patients and their situations, the same consideration was not afforded to me. I felt angry—should I have canceled on the same day and not considered their commute or their wait time for another appointment that would probably be rescheduled to months later? At this prepandemic time, there was not as much professional support for not working when sick as there is now (postpandemic), although at times it seems presenteeism may be creeping back into the expected work mentality. Televisits were starting but were only used for follow-ups and not for new patients. This experience made me create a boundary that focused on my well-being—I would not come in when I was sick. It felt like a no-win situation for me. The patients would be dissatisfied with a sick physician but also with a canceled appointment.

The COVID-19 pandemic highlighted the need for physician well-being. It increased awareness of physician suicide, early retirement, and an exodus from medicine compared with previous years.8,9 Furthermore, chaotic clinical environments exacerbated by COVID-19–related work conditions added to underlying time pressures, lack of work-home balance, work overload, and perceived lack of organizational support; these have all contributed to the Great Resignation in health care.8

In this spirit, I argue for my well-being. Sometimes I will have to say no, as I am human and need to support my emotional and physical well-being. Linzer et al10 noted that the explicit understanding of the unique challenges faced by women and people of color is crucial in demonstrating that all workers are valued and in creating a culture of equity and inclusivity. Acknowledging that physicians are human too and that women and other underrepresented clinicians also face unique challenges is vital for health systems to target areas of support for clinician well-being. It is crucial for us to see this as a problem not just about women or people with diverse backgrounds needing to change to be tougher or only setting boundaries to take care of themselves. There also need to be accountability, resources, support, and intentional action at the structural level, integrated into how things are done, so we can all more perfectly do no harm as professionals and not be harmed ourselves.

My profession is privileged to serve and help others; but, in this service, I still hold the right to be treated with kindness, compassion, and respect as a fellow human being. I now recognize that it is ok to say no. I am not a bad physician if I do. In fact, this helps me to be a better physician who values and supports my humanity. If we could remember the humanity of the physicians—of all of us—we can all create a system of care that mutually supports well-being, reduces burnout, and helps physicians with historically underrepresented identities feel less othered. We could return humanity to medicine for patients and ourselves as physicians. So, let us all commit to remembering humanity in health care and that physicians are human too.

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Article Information

Corresponding Author: Noriko Anderson, MD, MPH, Department of Neurology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA 94143 (noriko.anderson@ucsf.edu).

Published Online: November 4, 2024. doi:10.1001/jamaneurol.2024.3744

Conflict of Interest Disclosures: None reported.

Additional Contributions: I thank Joshua Budhu, MD, MS, MPH (Memorial Sloan Kettering Cancer Center), and Reiko Boyd, PhD, MSW (University of Houston), for review and feedback on this essay; they received no compensation.

References
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Griffin  JB  Jr. Interpersonal relationships. In: Walker  HK, Hall  WD, Hurst  JW, eds.  Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Butterworths; 1990.
2.
Sue  DW, Capodilupo  CM, Torino  GC,  et al.  Racial microaggressions in everyday life: implications for clinical practice.   Am Psychol. 2007;62(4):271-286. doi:
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Lacy  BE, Chan  JL.  Physician burnout: the hidden health care crisis.   Clin Gastroenterol Hepatol. 2018;16(3):311-317. doi:
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West  CP, Dyrbye  LN, Shanafelt  TD.  Physician burnout: contributors, consequences and solutions.   J Intern Med. 2018;283(6):516-529. doi:
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LaFaver  K, Miyasaki  JM, Keran  CM,  et al.  Age and sex differences in burnout, career satisfaction, and well-being in US neurologists.  ܰDZDz. 2018;91(20):e1928-e1941. doi:
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Sudol  NT, Guaderrama  NM, Honsberger  P, Weiss  J, Li  Q, Whitcomb  EL.  Prevalence and nature of sexist and racial/ethnic microaggressions against surgeons and anesthesiologists.  Ѵ Surg. 2021;156(5):e210265. doi:
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Dyrbye  LN, West  CP, Sinsky  CA,  et al.  Physicians’ experiences with mistreatment and discrimination by patients, families, and visitors and association with burnout.  Ѵ Netw Open. 2022;5(5):e2213080. doi:
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Abbasi  J.  Pushed to their limits, 1 in 5 physicians intends to leave practice.  Ѵ. 2022;327(15):1435-1437. doi:
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Kingston  AM.  Break the silence: physician suicide in the time of COVID-19.   Mo Med. 2020;117(5):426-429.
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Linzer  M, Griffiths  EP, Feldman  MD.  Responding to the Great Resignation: detoxify and rebuild the culture.   J Gen Intern Med. 2022;37(16):4276-4277. doi:
1 Comment for this article
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Humanism in Medicine
Pratibha Singhi, MD | Snr Prof and Head Pediatric Neurology Amrita Institute Of Medical Sciences Faridabad India, President International Child Neurology Association
Dr Anderson has the courage to express what is virtually a universal feeling among physicians in general and those related to diversity issues in particular. While we all talk of humanism in medicine, we forget that the same principle needs to be applied to the physician herself/ himself!
Over centuries, doctors have been taught to not only heal patients but to extend their care beyond their normal working hours or even working capacity! Most of us have gone through days and nights of continuous duties, forgetting to eat or drink, let alone having regular meals. At the end of
the day , we all feel very satisfied if our patient becomes better and we try to drown our hardships in this feeling. Also, doctors are sometimes labelled as being “next to God,” but this is only true until they keep working selflessly and the patient benefits out of this.
Societal values have changed over a period of time and now unfortunately the doctor-patient relationship has become more of a consumer oriented relationship . If the patient becomes well, it is of course the doctor”s job - no big deal! However if the patient does not improve in spite of the doctor ‘s best efforts, it is “the doctor”s fault/ negligence “ Whereas the doctors are meant to maintain their kindness and compassion, irrespective of the patients' behavior or demands, the patients seem to have the right to become aggressive and hurtful. Many doctors particularly those in resource limited countries face not just mental harassment, but also actual physical harassment wherein if a patient unfortunately cannot be saved, the micro aggression quickly escalates to macro aggression and many times the doctor's clinic and workplace have been torn down. There have also been reports in newspapers about doctors committing suicide because their reputation has been severely tarnished by unjustified complaints and even law suits by patients.
It is high time that the profession wakes up to this injustice and provides support in all spheres- mental, physical and legal to prevent doctors from aggression and harassment. While we all as a community are indeed privileged to be able to alleviate sickness and bring health and happiness in our patients' lives, we also need to take care of the health and happiness of our own professionals and build that in our professional systems. Humanism in Medicine should encompass humanism among the doctors for the patients as well as humanism for the doctors themselves.
CONFLICT OF INTEREST: None Reported
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