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Meier DE, Back AL, Morrison RS. The Inner Life of Physicians and Care of the Seriously Ill. JAMA. 2001;286(23):3007–3014. doi:10.1001/jama.286.23.3007
Author Affiliations: Hertzberg Palliative Care Institute, Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY (Drs Meier and Morrison); and the VA Puget Sound Health Care System, Department of Medicine, Department of Medical History and Ethics, University of Washington School of Medicine, Seattle (Dr Back).
The Patient-Physician Relationship Section Editor: Richard M. Glass, MD, Deputy Editor.
Seriously ill persons are emotionally vulnerable during the typically
protracted course of an illness. Physicians respond to such patients' needs
and emotions with emotions of their own, which may reflect a need to rescue
the patient, a sense of failure and frustration when the patient's illness
progresses, feelings of powerlessness against illness and its associated losses,
grief, fear of becoming ill oneself, or a desire to separate from and avoid
patients to escape these feelings. These emotions can affect both the quality
of medical care and the physician's own sense of well-being, since unexamined
emotions may also lead to physician distress, disengagement, burnout, and
poor judgment. In this article, which is intended for the practicing, nonpsychiatric
clinician, we describe a model for increasing physician self-awareness, which
includes identifying and working with emotions that may affect patient care.
Our approach is based on the standard medical model of risk factors, signs
and symptoms, differential diagnosis, and intervention. Although it is normal
to have feelings arising from the care of patients, physicians should take
an active role in identifying and controlling those emotions.
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