Feelings are tricky in medicine

Sharing an opinion is harder than it may seem.

I tend to shy away from sharing my opinion unless I have data to back it up. After all, scientific data is the cornerstone of truth and integrity in medicine. But data, among academics, can also be a defence mechanism. For example, it’s usually less threatening when someone counters an argument with data than when someone questions your opinion.

Sharing an opinion exposes what we value, and it reveals our vulnerabilities. When someone questions our opinion, it can feel less like an academic debate and more like a personal attack. Data can be debated; feelings can be judged.

But here’s my opinion: feelings are tricky in medicine, and I don’t think we talk about them enough.

Of course, we inquire about our patients’ feelings. We validate and document their emotions, and we empathize, grieve, and rejoice alongside them. We keep their confidence. In many cases, we can’t help it—we absorb, reflect, and ruminate over these difficult interactions, and then we repeat the cycle.

But how often do we ask each other about our feelings?

In my position as editor-in-chief of the BCMJ, I have the privilege of hearing physicians’ voices from across the province, and I believe our profession is hurting. The heavy mental, physical, and emotional load required to do our jobs is taking a toll. Physicians often write to the BCMJ about burnout in medicine. But what do we really mean by burnout?

Burnout has become an accepted placeholder word, one that conceals a spectrum of quieter, harder-to-name emotions. Burnout is less personal and implies that a systems issue, rather than an emotional one, is the root cause of one’s failure to thrive at work. Underneath may lie guilt, shame, sadness, anger, fear, numbness, loneliness, or despair. Some of these feelings may be related to our careers—to the moral distress of working in a system that cannot meet our patients’ needs or to the grief that accompanies inevitable poor outcomes in health care. But many feelings are deeply personal and unrelated to medicine. Physicians are human, after all. How can we normalize acknowledging that humanity?

Perhaps we keep silent because we don’t want to burden each other, or we fear being penalized if getting the help we need interferes with our patients’ needs, our complex schedules, or regulatory expectations. Perhaps burnout also conceals a slow erosion of connection to purpose and meaning.

Medicine has long rewarded stoicism. We value resilience, objectivity, and data. We are trained to recognize pathology . . . but not every feeling needs to be pathologized. Feeling is not at odds with being a good physician; it’s often the reason we are here.

When I review authors’ clinical submissions, one of the most common things I ask them to include is a list of resources that might help BC physicians with the subject matter. I wish I had a simple list of resources that would meaningfully address this problem. Of course, there’s the Physician Health Program, and I hope you will write in and tell me about other resources. But what I believe would help the most is a broader, more open conversation around physician mental health—one that goes beyond burnout.

If you would like to share your feelings, experiences, or perspectives on mental health, please write to us at the BCMJ. We are listening.
—Caitlin Dunne, MD, FRCSC