Physicians’ Emotional Reactions to Patients

Abstract

The purpose of this study was to determine which circumstances and behaviors of patients elicit the greatest emotional reactions in experienced internists. A questionnaire, generated from interviews with physicians, was mailed to every other board-certified internist in St. Louis. They rated their "degree of emotion" in response to each of 33 statements about different patient behaviors or circumstances. Questionnaires were returned by 59 (22%) of 265 physicians. The mean respondent age was 50 years and the mean year of medical school graduation was 1960. The 11 statements rated as having the highest degree of emotional reaction focused upon threats to physician integrity or self-esteem. The intermediately rated group of 11 statements focused upon clinical circumstances where patients were demanding or upset, creating undue demands on the physician. The 11 statements with the lowest rated emotional responses focused upon patient circumstances that were more objectively unalterable or were independent of the physician. With physicians divided in four groups by year of graduation, there were no differences among mean ratings for any of the 33 statements. The authors conclude that the greatest emotional reaction resulted from threats to physician integrity or self-esteem and that these responses did not abate with experience. These results pinpoint specific areas for those interested in teaching and studying the physician-patient relationship.