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Exploring the Roles of Emotion and Bias in Caring for Patients

Patient telling symptoms to doctorHow we think about emotion affects not only the meanings we ascribe to situations, events or people but also our possible future actions.

In medicine, emotion is central to the work carried out by health professionals daily. Understanding, reflecting on, engaging with and expressing emotion are important aspects of practice.

That healthcare professionals need to be able to make objective and rational decisions is not in dispute. But on a practical level, how do a doctor’s feelings toward a patient affect decision making and potential outcomes? Is a doctor more likely to provide better care to a patient whom the clinician finds affable than to one considered a complainer?

Opening the door to bias
If we think about emotion as part of our physiological makeup or immutable disposition, we may open the door to attribution bias. Attribution theory suggests that individuals have differences of perception regarding the causes or consequences of behavior based on the assumptions they make.

Studies indicate that we are remarkably inclined to excuse our own behavior in terms of task difficulty or situation (“The dog ate my homework”) while attributing dispositionally to the behavior of others (“They are lazy”). This can affect whether we move toward our patients, colleagues or students to help, or move away in order to avoid contact.

Statements or thoughts such as “She is just like that,” “He doesn’t care” or “They will never change” are ways of attributing emotional responses to an individual’s character or gender or physiology. Those responses can affect how a clinician attaches meaning to a given situation and may influence future actions.

Confronting emotional bias
We all make decisions about each other based on assumptions and this happens in a split second. However, unrecognized assumptions in decision making by healthcare providers holds potential for serious consequences. This is true for collegial relationships as well as those with patients. “Should some behavior be ignored? Reported? Or should the person be confronted directly, colleague to colleague. Provided you recognize your own bias, what should you do?

The problem of reason
Another taken-for-granted idea that may affect health professionals’ practice is that we can somehow separate our emotions from reason and can leave out emotion in thinking and problem solving. A saying such as “He lost his head” refers to someone who can no longer think clearly because he is emotional. The role of emotion in this process is not always clear. Increasingly, research suggests that our cognition is essentially emotional; there is no split between the two. Antonio Damasio states in his book Descartes’ Error: Emotion, Reason and the Human Brain, “When emotion is entirely left out of the reasoning picture . . . reason turns out to be even more flawed than when emotion plays bad tricks on our decisions.”

Preparing for emotions
How do we prepare trainees to acknowledge and reflect on their emotions as a valuable source of information and knowledge and also deep connection to their professional work? One second-year medical student put it this way in a study on the subject of emotions in medical school: “Those feelings just get in the way. They don’t fit, and I’m going to learn to get rid of them. Don’t know how yet.” As if she could practice getting rid of them.

A faculty member observed, during a talk I recently gave at Einstein, that during training there is so much focus on “difficult” patients and negative emotions that clinical educators may overlook preparing students for the sometimes profound feelings of attachment—and yes, even love—that experienced physicians can feel toward their patients.

Training to establish connections
Emotions are more than physiological attributes located inside our heads and bodies, and more than psychological phenomena or mutable skills that can be improved and managed through training. It is helpful to have ways of practicing skills related to emotional behavior, but medical education is not well served by these alone. Emotions are also a medium of exchange among people, connecting us to one another and to larger social concerns. They are part of a practical ethics that takes into account the effect of our emotions on one another and our social environment.

Perhaps we need to start collectively acknowledging and working with emotion in a way that moves us beyond thinking about the individual as an “emotion container” and allows us to question further the split that we unthinkingly assume exists between emotion and rationality.

Editors’ Note: Nancy McNaughton was recently at Einstein to discuss the role of emotions in medicine during the Introduction to Clinical Medicine Program’s Annual Faculty Development Day.

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