Karina holds her face in her hands and rocks back and forth, cursing under her breath. You are seeing her for an annual physical before she leaves home to attend college in a neighboring state. As her primary care physician, you’ve known Karina for 3 years and have never been concerned about her health or development. Today, despite her layers of clothing and makeup, she appears emaciated. Your older sister struggled with an eating disorder when you were growing up, so you tend to notice when someone has lost weight quickly.
After a brief conversation with Karina about her summer, you ask, “Have you had any issues with dizziness or feeling more tired than usual?” “Have you noticed a change in your appetite or eating habits?” “Any recent stressors in your life?” Karina’s consistent answer to all of these questions is a simple “no.” She doesn’t make eye contact. When you bring up the change in her weight, she slams her hand on the counter and says, “That’s it. I’m done talking to you. You obviously don’t get it. Don’t pretend like you care. Nobody gives a damn.”
She stares at you, and you stare back. You wait. You try to create space. She stares at her feet. You wait a little longer. Eventually, you say, “Help me understand.” This is when she begins rocking back and forth again. You get halfway through her physical, but when you ask if you can proceed with an abdominal exam, Karina abruptly sits up and runs out of the exam room. Everything happens too fast for you to react or respond. You’re left with a half-completed college physical form, a delayed clinic schedule, your own unsettled feelings and an uneasy sense of apprehension about Karina’s well-being.
Challenging emotional scenarios like this one—based on a real clinical encounter from one of this chapter’s co-authors (with the name changed)—are common in clinical practice. Healthcare is inherently emotional, and directly impacts the physical and psychological well-being of patients and clinicians alike. Of course, patients and clinicians experience positive emotions of joy, relief, and satisfaction when engaged in collaborative, mutually healing care. But experiences of illness may unearth deep-rooted feelings of sadness, anger, guilt, shame, denial, loneliness, fear, inadequacy, confusion, and more in patients and clinicians. Clinicians may inadvertently trigger these emotions within a clinical encounter, causing unintended harm to the patient. Conversely, clinicians caring for ill patients are vulnerable to stress, vicarious trauma, compassion fatigue, the opening of personal wounds, and a negative sense of self due to perceived failures–all of which contribute to the growing prevalence of perceived moral injury and burnout among healthcare workers.1 These emotions are further complicated by each individual’s experience in a labyrinthic healthcare system plagued by increasing administrative burden, rising costs, widening disparities in access and outcomes, and a long history of structural racism, homophobia, transphobia, and other forms of structural ...