Managing Emotions in Medical School: Students' Contacts with the Living and the Dead

Abstract

Professionals are not supposed to feel desire or disgust for their clients, and they presumably begin to learn "affective neutrality" in professional school. Medical students learn to manage the inappropriate feelings they have in situations of clinical contact with the human body, but two years of participant observation revealed that the subject of "emotion management" is taboo. Yet the culture of medicine that informs teaching also includes a hidden curriculum of unspoken rules and resources for dealing with unwanted emotions. Students draw on aspects of their training to manage their emotions. Their emotion management strategies include transforming the patient or the procedure into an analytic object or event, accentuating the comfortable feelings that come from learning and practicing "real medicine," empathizing with patients or blaming them, joking, and avoiding sensitive contact. By relying upon these strategies, students reproduce the perspective of modern Western medicine and the kind of doctor-patient relationship it implies. How do I set aside 25 years of living? Experience which made close contact with someone's body a sensual event? Maybe it's attraction, maybe disgust. But it isn't supposed to be part of what I feel when I touch a patient. I feel some of those things, and I want to learn not to. (Third-year, male medical student.) All professionals develop a perspective different from, and sometimes at odds with, that of the public (Freidson 1970). "Professionals" are supposed to know more than their clients and to have personable, but not personal, relationships with them. Social distance between professional and client is expected (Kadushin 1962). Except for scattered social movements within the professions in the late 1960s and 1970s that called for personal and egalitarian relationships with clients (Haug and Sussman 1969; Kleinman 1984), professionals expect to have an "affective neutrality" (Parsons 1951) or a "detached concern" for clients (Lief and Fox 1963). Because we associate authority in this society with an unemotional persona, affec

Identity change and the human dissection experience over the first year of medical training

“…This reflects previous findings that medical students often utilise defensive strategies to minimise anxieties arising from conducting human dissection (e.g., Abu-Hijelh et al, 1997;Charlton et al, 1994;Sanner, 1997). Smith and Kleinman (1989) noted how defensive strategies, such at overly intellectualising the process of human dissection, could allow students to become more involved in the process of learning in which they "gradually come to see the human body as an interesting object, separate from the person" (p. 65). This sentiment was reproduced by our female participant who, towards the end of her first year, articulated the construct 'a learning tool -a body'.…”

Students’ views on the impact of peer physical examination and palpation as a pedagogic tool for teaching and learning living human anatomy

“…Routine physical examination of patients requires a physical intimacy that could evoke strong feelings in a personal context that are regarded as unprofessional in medical practice. Smith III and Kleinman (1989) reported that as medical students encounter the human body, they experience a variety of uncomfortable feelings including embarrassment, disgust and arousal. Medical students often struggle with knowing how to deal with these feelings in their initial encounters with patients (Haas & Shaffir 1982).…”

The Emerging Field of Emotion Regulation: An Integrative Review

“…This circumvents the confusion that was created in the stress and coping literature by predefining defenses as maladaptive and coping as adaptive (Parker & Endler, 1996). Thus, cognitive strategies that dampen negative emotions may permit medical professionals to operate successfully (Lief & Fox, 1963;Smith & Kleinman, 1989). The same strategies, however, may be used to dehumanize an enemy and neutralize empathic distress that could interfere with state-sanctioned killing (Bandura, 1977).…”