It is normal for clinicians to experience an array of emotions when interacting with ill patients and their families. Although positive emotions such as joy and satisfaction are rarely problematic, negative emotions such as anger or sadness may interfere with the ability to communicate empathically or even to provide suitable medical care.

Some of these emotions are direct reactions to what the patient is saying or doing (e.g., an angry patient may trigger our own anger). Difficult emotions may also arise when patients do not act in ways that we like (e.g., frustration when a patient is not taking medication as prescribed). We may feel sad, helpless, or even guilty when we cannot prevent a patient from further illness or death. We may also experience emotions triggered by our own past experiences, such as a patient who reminds us of a family member (e.g., grief, longing).

Strategies for managing difficult emotions.
Dealing with one’s emotions is a learned skill — it takes time and practice. Be patient and keep practicing; look at each experience as a learning opportunity.
Prior to an interaction you anticipate will be difficult, identify what is causing your emotional response. Is it the patient’s health behavior, their behavior toward you, their intense emotions, or your own sadness about their condition? If your emotional response is based on your past, acknowledge this and put it aside during the upcoming interaction.

Practice the interaction ahead of time. Imagine the most likely ways that the patient will react and how you will respond.
• Clarify your goals. It is unrealistic to think you can prevent or control patients from experiencing difficult emotions, especially anger and grief. Acknowledge this and focus on achievable goals: being empathic, listening, disclosing medical information, talking patients through options, and validating their emotions.
• Don’t go it alone. Bring along a colleague or team member who can help if you have trouble controlling your emotions and can give you feedback on what might work better next time.

During the interaction, recognize when your emotions are having an impact on your thinking or communicating.
• Increased heart rate; feeling flushed, sweating; shallow, rapid breathing; increased muscle tension; speaking rapidly or loudly; repeating yourself; or realizing you are not listening.

If you are experiencing intense negative emotions, try these tactics.
• Give yourself and the patient time to allow emotional intensity to subside. Listen, rather than speak; allow silence.
• Validate the patient’s experience by naming their emotions. If you are not sure, pose it as a question. Simply naming what is happening may attenuate your own emotional response.
• Naming your own emotions is appropriate as long as it does not divert attention from the patient’s needs or put blame on the patient.
• If you are feeling overwhelmed, it is appropriate to step outside the room; resume your interaction once composed.
• Most patients appreciate certain displays of clinician emotion. However, losing control of one’s emotions, including grief, is never appropriate in front of patients.
• Afterwards, debrief with a trusted colleague or team member about what happened, how you responded, and how you might do it differently next time. A less emotionally involved person can often identify things in the interaction that you cannot.

See reference for more information.

Adapted from Posluszny S and Arnold R. Managing one’s emotions as a clinician. Palliative Care Network of Wisconsin. Fast facts and concepts #203. Internet. Accessed on December 31, 2019.