A non-medical friend recently asked me, “When was the last time you cried with a patient?” I reflected for a few minutes but could not immediately remember if I had ever shed tears while with a patient. I thought back to crying while walking back from work a few days, and did eventually remember an instance where I actively cried with a patient. Realizing how uncommon this was for me, I recalled how fortunate I was to have witnessed a perfect example of this on my very first rotation as a third-year medical student.
I had barely begun my very first rotation. My attending and I entered the room of a young woman with metastatic cancer. She looked frail as she slept propped against some pillows. Dr. K, the attending physician, explained the options to her and her husband. They could 1) do nothing and go home, but her condition would certainly worsen in a matter of days to weeks or 2) try to have a percutaneous tube, with the possibility that they may need to convert to a larger surgery.
The patient asked, her voice tremulous, “If we hypothetically did move forward with the procedure, what would be coming … afterward for me?”
Dr. K took a moment and replied, “There is really nothing more we can do in terms of stopping your cancer at this point, and we want to do everything we can to give you the best quality of life … so what that means is hospice care.”
Both the patient and her husband were clearly holding back tears, pondering these words, when Dr. K began, “Let me tell you something.”
“Please don’t make me cry,” the patient said softly.
Dr. K went on to share a story about his own aunt in hospice care, and how the hospice team checked on him and his family even after his aunt passed away.
“And even though I’m in this field, I can’t tell you how much it meant that they were there for me. And I want people to be there for you and your family too because I know how hard this is.” He wiped at his tears and asked, “Is there anything else I can do for you?”
“Yeah,” the husband said. “You can give me a hug.”
There was not a dry eye left in the room, myself and nurses included, as I wiped away my tears, smiling, looking on as Dr. K embraced the patient’s husband.
While I have seen other instances of delivering bad news, this was the first time I saw an attending physician shed tears. I am someone who can cry at the drop of a hat, so I had always worried about what patients and the rest of the team would think if I ever cried while delivering bad news. Seeing Dr. K open his heart to our patient and her family taught me how expressing our feelings through tears is not a weakness that should be hidden, but rather a strength.
Doctors, nurses, and medical students all report crying in hospitals, for reasons ranging from feeling empathetic, to the suffering of their patients, to burnout. One study in particular found that while medical students have the lowest self-reported rates of crying, they also have the highest rates of negative consequences for showing emotion (like being mocked for crying, or viewed as being unprofessional or even weak). But while these negative opinions can carry through even on to being attendings, higher negative attitudes toward expressing emotion are related to higher burnout scores. Thus, one of the ways to fight burnout may include being more accepting of expressing emotions with patients.
Sometimes health care workers erect a wall between ourselves and our patients, an unintentional “othering.” While this is usually to prevent ourselves from getting overwhelmed with all the grief and illness that surrounds our daily work, this can also make health care practitioners seem robotic and unempathetic. I am very fortunate to have witnessed this poignant experience so early on in my medical training; Dr. K taught me that instead of trying to put on a stoic appearance and hiding our emotions for the sake of seeming professional, sometimes expressing our feelings as we connect with our patients is one way of breaking down the wall and demonstrating that we are on their team as we all work toward helping them get better. There are many ways to build rapport, and perhaps it is now time to think about crying with our patients as a way to help us demonstrate to our patients that we are firmly and fervently on their side — for both their sadness and their joy.
When's the last time you cried with a patient?
Noor Shaik is in her preliminary intern year as part of the neurology residency program at the Hospital of the University of Pennsylvania, Philadelphia, PA.
All names and identifying information have been modified to protect patient privacy.
Illustration by April Brust
