Sohaib Arshad  ( Department of Periodontology Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia )
Nasar Um Min Allah  ( Department of Periodontology, Foundation University College of Dentistry, Islamabad, Pakistan )
Mohammad Fadhli Khamis  ( Forensic Dentistry/Oral Biology Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. )

https://doi.org/10.5455/JPMA.59669

 

 

Madam, recently came across an incident in the emergency department of a well-known hospital in Islamabad where I saw a doctor crying with a patient which compelled me to write on physician's tears. In a society where doctors are considered as the pain healers and their jobs are to bring good and bad news, dealing with patients suffering and losses, having such incidents raises certain concerns including emotions crying of physicians to be justified? Or is a physician allowed to show their human nature during such moments? And how a physician feels to cry in the presence of a patient? In a healthcare setting, crying is common, though an understudied topic. Major reasons include having compassion towards a dying patient, intensive doctorpatient relationship or the emotional/stress sob. This phenomenon seems to happen with many doctors, but majority are unwilling to accept it as it may appear as their weakness, lack of control or incompetence. Some patients prefer a physician who is more compassionate with them whereas others prefer physicians who are reserved from the suffering of a patient. The results of the Dutch survey¹ on the general population showed that half of the respondents disagreed with the notion that a physician crying in the presence of a patient is acceptable as such a reaction may increase the physician's risk of burnout² whereas one third of the respondents considered it to be appropriate. It doesn't indicate that crying physicians are not suitable for their job. More than half of the patients still considered crying physicians to be suitable for the job.³ A problem that arises is to maintain a balance between professional equanimity and the expression of sympathy. However, it's increasingly recognized as unhealthy for doctors to bottle up their emotions. Moreover, a recent study⁴ also showed that physicians generally feel it acceptable to cry over the bad situation of a patient, both in the presence or absence of patients. In contrast, other reasons, such as private circumstances or conflicts at work are deemed not appropriate to cry about in the presence of a patient. Empathy and compassion, as evidenced by tears, can certainly facilitate the doctor-patient relationship and may contribute to a healing climate. Stress is also one of the reasons and many doctors will have experienced having been pushed to their limit, causing them to cry privately because they feel unable to cope. Research studies have shown that due to stress the proportion of mental health problems are increasing in the medical community. Moreover, depressive symptoms in doctors have been linked to higher chance of burnout.⁵ Lastly, further study on this subject is strongly needed to better comprehend it and how and when it may interfere with or promote the therapeutic mechanism.

 

Acknowledgement: The authors would like to thank Dr. Hina Abbas for her valuable ideas and suggestions on this topic.

Disclaimer: None to declare.

Conflict of Interest: None to declare.

Funding Disclosure: None to declare.

 

References

 

1. van Loghum BS. Research on crying nurses. Bijzijn XL 2015; 8:6.

2. Lerner B. At Bedside, Stay Stoic or Display Emotions? News release. The New York Times Media Centre. [Online] 2008 [Cited 2019 August 02]. Available from URL: https://www.nytimes.com/2008/04/22/health/ views/22essa.html.

3. Bassett EZA, Finlay F. Cry a little tenderness? Do doctors cry and is this acceptable? Arch Dis Child 2015; 100(Suppl 3):A217-8. Doi: 10.1136/archdischild-2015-308599.459

4. Janssens KME, Sweerts C, Vingerhoets AJJM. The Physician's Tears: Experiences and Attitudes of Crying Among Physicians and Medical Interns. J Clin Psychol Med Settings 2019; 26:411-20. doi: 10.1007/s10880-019-09611-9.

5. Rogers ME, Creed PA, Searle J. Emotional labour, training stress, burnout, and depressive symptoms in junior doctors. J Vocat Educ Train 2014; 66:232-48. Doi: 10.1080/13636820.2014.884155.