What about you?

Michael Fisch knew exactly when his work with dying patients was beginning to affect him personally. Fisch, an associate professor of gastrointestinal medical oncology at M.D. Anderson Medical Center in Houston, says the revelation came soon after his mother had developed the lung cancer that eventually killed her. He recalled talking at length with her to answer several detailed questions but did not feel any emotion during or after the conversation.

“I realized that when I got into my clinician role, emotion disappeared for me, and it was the sign of an over-tightened emotional spigot,” he says.

Fisch cautions other physicians who work with patients who are seriously ill to:

• Be alert for changes in their own feelings or reactions when giving bad news;
  
  
• Acknowledge when they might be feeling too little or too much emotion; and
  
  
• Work through their issues by attending communications workshops that involve role-playing and observation by colleagues and trainers.

Sometimes, it may be more comforting to seek support and feedback from distant colleagues rather than those with whom you work daily, he says.

“You have to be able to quiet your own voices,” McCormick says. “If you want to run out of the room, you’re thinking too much about yourself and you’re not going to be much help to the patient."

”For that very reason, Old says it is common to see physicians erect mental and emotional barriers to avoid getting too involved in a patient’s care. “A balance is needed and it’s sometimes very hard to find,” he says.

Wollner says it is important for physicians to find a safe place or “safe” colleagues with whom they can discuss emotions.

“There have to be sanctioned areas — clearly designated places you can go to piss and moan, talk about it, try and work through it,” he says.

McCormick recommends that physicians embrace a dual role — as both curative and palliative care providers rather than one or the other. That way, they will never feel that they abandoned the dying patient.

“When the medications don’t work anymore you can still have something to offer patients instead of just stopping your care and turning them over to the hospice people,” he says.