Is it okay for GPs to cry at work?

Evelyn Lewin

1/05/2019 1:42:55 PM

There are many reasons doctors can be brought to tears. Dr Evelyn Lewin asks the question: Is crying at work acceptable for GPs?

Woman crying to another
An Australian study found 57% of hospital doctors had cried at work.

Scrolling through medical journals recently, a headline caught my attention.
Published in the BMJ, ‘Should doctors cry at work?’ found that many doctors cry at work – for a variety of reasons. According to the authors, those reasons include ‘compassion for a dying patient, identifying with a patient’s situation, or feeling overwhelmed by stress and emotion’.
The article cited research from an Australian cross-sectional study that used self-reported questionnaires.
It found crying was frequent at hospitals, with 57% of doctors and 31% of medical students having cried at work at least once. The study also found that women cried considerably more than men.
The main reason for respondents’ crying was identification and bonding with suffering and dying patients or their families.
That certainly makes sense to me.
After all, there is no escaping pain, suffering, dying and death in a hospital environment. Add into that mix overworking, exhaustion and stress, and it’s easy to understand why hospital doctors are often brought to tears.
When I looked further into the topic, I began to realise that all of the articles I came across discussed the concept of doctors crying in a hospital setting.
But what about GPs?
Is it common for GPs to cry at work? And, as all of the articles on hospital doctors discussed, is it considered ‘okay’ for GPs to do so?
To explore this topic, I decided to ask a couple of GPs about their opinions.
Dr Fiona Bisshop, a GP with a special interest in LGBTQI health, believes it’s okay to cry at work as a GP.
‘I’ve cried as a GP,’ she told me. ‘Sitting with my patient whose teenage son ended his life the week before, unable to distance myself from this horror, and imagining my own son.
‘I’ve cried when telling a patient I’ve known for nearly 20 years, at their bedside at home, that their time has come.
‘Crying is a human reaction. It is a sign of empathy.’
GP and medical educator Dr Libby Hindmarsh has also cried at work and agrees that it conveys a level of empathy.
However, she believes there is a difference between getting misty-eyed and becoming inconsolable.
‘It is appropriate for GPs to shed a tear, but be very careful that the patient understands that they are not distressing you,’ she said.
‘It is not the patient’s role to be supporting the doctor. The patient’s needs and care need to remain the focus.’
Dr Bisshop feels the same way.
‘Of course our patients also need to see us as strong and dependable, not some blubbering emotional mess who can’t keep it together,’ she said.
Psychiatrist and psychotherapist Dr Caroline Walker told the BMJ that it can be ‘meaningful and appropriate’ to cry when something terrible is happening to a patient.
But, she added, context matters.
‘Crying with the patient is a bit like self-disclosure: it’s fine if it’s in the patient’s interest and doesn’t take the consultation away from them,’ she said. ‘It’s about being with them in that moment, being real and honest.’
In my own experience, I believe our patients crave that ‘realness’ and honesty. I think shedding a tear with our patients shows that we are not only listening to them, but that we care deeply.
I am not saying, however, that staying dry-eyed is a sign we don’t care.
Rather, in the right context and in a controlled way, I believe crying is not a sign of weakness, nor lack of professionalism.
And yet, the BMJ story pointed out that some doctors and medical students worry that crying conveys such negative connotations. An article in BMC Medical Ethics explored that idea.
‘Physicians are routinely trained to remain detached from their own as well as their patients’ emotions, perpetuating the ideal of the skilled and cool-minded professional,’ the article noted.
‘Although a certain degree of detachment is important for doctors, over-detachment characterised by emotional neglect and denial can have serious consequences for both physicians and patients.’
The authors concluded that, ‘empathy should not only be expected from doctors but should be actively promoted, assisted and cultivated in the medical profession’.
Of course, there is the other kind of crying that doctors do at work. That is, sobbing from their own stress or burnout. And while I’m not ashamed to admit I have done my fair share of that after hours as a hospital doctor, I have never cried in front of a patient for this specific reason.
Both Dr Bisshop and Dr Hindmarsh agree doing so would be inappropriate.
If you find yourself crying uncontrollably at work, Dr Walker believes you need to seek professional support. But if you feel tears spring to your eyes when you’re with a patient because their story has moved you, don’t beat yourself up about it.
‘Crying can help our patient to know they are heard, and that we care,’ Dr Bisshop said.

burnout crying crying at work emotions stress

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Anonymous   2/05/2019 11:17:42 AM

I’ve wept twice at work. Once in a disaster situation when I felt I couldn’t go on and again with a patient who’s son who was due home within a week had been killed in combat. As a GP with a psychiatry background in the 2nd case that level of boundary dissolution has always been clinically challenging to reconcile so I welcome this work. Thanks

K Akbar   3/05/2019 8:43:38 AM

Totally agree That crying is okay when it is a form of empathy and a natural reaction. It is a form expression that should be allowed while listening to someone’s difficulty.