I wash my hands of this: A plea for emotional hygiene

As a recent graduate of a Canadian medical school, it has been cemented in my brain that I am to wash my hands before and after every patient interaction. I’m grateful for this practice, which keeps me and my patients safe from contagious infections. What is taught with much less emphasis, however, is the transmission of emotions from one patient interaction to the next. I suspect that just as bacterial and viral infections can be passed from one patient to the next, then even taken home with the practitioner, so too can emotional trauma.

As medical practitioners we are given the immense privilege of being welcomed into the personal emotional world of many of our patients. Trauma, mental health issues, and difficult social situations are common reasons why a patient seeks care from their health care provider. We are trained, and even selected, by medical schools and residency programs to be compassionate and empathetic; this means we will feel the pain alongside our patients. Even the emotional trauma of a devastating physical diagnosis can leave us feeling depleted and raw.

In medical school we are taught about transference and countertransference; the former being when a patient projects their experiences with another person onto the practitioner, the latter being from practitioner to patient. If traumas are not acknowledged and given the space to dissipate, it is inevitable that we will end up projecting our experiences onto future patients. Similarly, initiating a patient encounter with depleted psychological reserves may lead to inferior patient care. At the end of the day we take the compounded trauma back to our personal lives, with possibly few reserves left to manage them.

In a busy practice there is simply no time to fully address our emotional reaction to every situation. However, a small amount of recognition, respect, and mindfulness around the effects of these events may help to prevent many of the negative consequences. I will make a proposal, even a plea, to my medical colleagues: just as you wash your hands between patients, acknowledge the emotional baggage that you bring with you from the previous patient encounter, and greet your next patient with presence and a clean heart. Just as I do a thorough hand washing before heading home each day, I would argue for instituting a type of emotional scrub in the form of a check-in, either with yourself or with a colleague, to address the burdens of the day so you don’t take them home with you.
—Justine Spencer, MD
UBC Family Practice PGY-2