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Abstract
Seriously ill persons are emotionally vulnerable during the typically protracted course
of an illness. Physicians respond to such patients' needs and emotions with emotions
of their own, which may reflect a need to rescue the patient, a sense of failure and
frustration when the patient's illness progresses, feelings of powerlessness against
illness and its associated losses, grief, fear of becoming ill oneself, or a desire
to separate from and avoid patients to escape these feelings. These emotions can affect
both the quality of medical care and the physician's own sense of well-being, since
unexamined emotions may also lead to physician distress, disengagement, burnout, and
poor judgment. In this article, which is intended for the practicing, nonpsychiatric
clinician, we describe a model for increasing physician self-awareness, which includes
identifying and working with emotions that may affect patient care. Our approach is
based on the standard medical model of risk factors, signs and symptoms, differential
diagnosis, and intervention. Although it is normal to have feelings arising from the
care of patients, physicians should take an active role in identifying and controlling
those emotions.