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On Moral Injury and Emotions in Medicine

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“The Doctor’s Art” is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.

As one of the most prolific and acclaimed physician-writers today, Danielle Ofri, MD, is the author of seven books on the intricacies of modern medical practice and the doctor-patient relationship. Her writing has appeared in The New York Times, The Atlantic, and The New Yorker, in addition to various leading medical journals. She is also the co-founder and editor-in-chief of the Bellevue Literary Review, a literary journal that publishes work focusing on the human body, illness, and health. In her writing, Ofri uses vivid narratives to shed light on the highs and lows of being a doctor.

In this episode, she joins Henry Bair and Tyler Johnson, MD, to share her path to medicine, how doctors can mitigate the moral injury they experience in their work, and how storytelling can comfort us in times of suffering.

In this episode, you will hear about:

1:54 How Ofri was initially drawn to internal medicine through the patient stories she encountered6:07 A discussion of the tension between the business and art of medicine11:29 Ofri’s advice on how clinicians can combat the moral corrosion that broken medical systems can induce16:33 How Ofri’s medical residency during the AIDS epidemic led to her passion for writing23:30 Ofri’s writing process27:09 A discussion of the moral philosophy of medicine and why doctors do what they do31:47 Ofri’s reflections on how her writing has impacted her clinical practice34:38 The wisdom that physicians who encounter suffering every day can share with a world experiencing collective grief from the COVID-19 pandemic42:25 A discussion of the emotional toll on clinicians from delivering bad news and confronting grief, and an exploration of guilt and shame48:44 Ofri’s advice to clinicians on how to stay connected to the meaning in medicineFollowing is a partial transcript (note errors are possible):

Bair: You have led such an incredible career in narrative medicine, and we’re going to get to all of that. But first, can you take us all the way back to the start and tell us what drew you into a medical career?

Ofri: It’s interesting because nobody in my family is a doctor. Everyone’s a teacher. And when I grew up, I always wanted to be a vet because I loved my dog. But then in high school, it seemed that everyone who likes science was going to be a doctor, so I just followed along. And the truth is, I had no idea, honestly, what it is that doctors did. But that’s what you were supposed to do. So that’s what I said I was going to do.

But I ended up going to undergraduate in Canada at McGill, a little bit by happenstance, because it had a late application deadline and I was a bit tardy in that department, but I did not know I was getting myself into a British educational system where it’s 100% science, with no arts at all. And so you weren’t just a pre-med, you had to be a physiology major or biochemistry or microbiology, very specified. So I found myself as a physiology major, and that’s where it seemed that everyone who likes science was going to be a scientist. Medicine was just for technicians, and I really had never thought about a scientific career, but that’s where this path was leading.

And then I found out about the joint MD/PhD program, which seemed the perfect solution to my dilemma. And so I did the MD/PhD program because I figured I’ll do both things and I’ll figure out at the other end which one it is that I like. And the icing on the cake was that they would cover my tuition for that. So it was a great deal. And so I went and did the MD/PhD program.

I had a really wonderful time. I loved doing my PhD. I did opiate receptor signal transduction work at a kind of biochemistry lab, and I thought I was going to be a neurologist, but I’d be a bench scientist, do a clinic 1 day a week in neurology because I was doing neuroscience. So I did a 1-year medical internship in preparation for neurology, and I completely fell in love with general medicine and I fell in love with the patient stories.

And I even remember the patient, who was Mr. Feliciano, not quite his real name, but he was a gentleman admitted for endocarditis — infection of the heart valves — which required multiple weeks of antibiotics, and he didn’t have insurance to get home antibiotics. So he was in the hospital for a very long time, and it fell to me as the intern to go every day, you know, do his vitals, do an EKG, check his heart. And each day he told me a little bit more about himself. And I got to know him really well over the course of, I don’t know, 6 or 8 weeks.

And I became fascinated with the depth of how you would come to know a patient, especially when they’re presenting sort of a persona. In this case, he was a bit of a drug user. He was a bit on the edge of society, and yet he had such a rich and wonderful personality and story that I got to know as I spent time with him. And that’s what really kind of sucked me toward clinical medicine. And, of course, I ended up in the end doing primary care.

For the full transcript, visit The Doctor’s Art.

Copyright © The Doctor’s Art Podcast 2022.

Source : MedPageToday

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