Learning Professionalism Under Stress

As a medical trainee, developing professionalism is a core goal of my education. Unlike technical and knowledge-based competencies, professionalism captures an all-encompassing attitude; it is more of a virtue than a skill. In an ideal world, the virtues of professionalism—honesty, integrity, commitment, compassion, respect, altruism—would govern all human interactions. However, in health care, professional attitudes are often challenged in emotional, stressful, and tiring situations. One particular patient encounter during my emergency medicine rotation highlighted this challenge. The young man arrived by ambulance at 5:00 am near the end of my overnight shift. He had been in an altercation and had suffered knife injuries to his face. He was intoxicated and belligerent; his swearing reverberated throughout the department, announcing his presence to us. As he was led into the ER, I noted multiple lacerations across his cheeks and forehead from which he was bleeding profusely. The nurses’ attempts to clean away the blood were met by offensive sexual comments. I approached the patient and our gazes met. “Quit looking at me like you want to fuck me!” he swore, jumping towards me. My initial shock gave way to anger, and I felt my blood boil with indignation. The staff physician intervened, conveying to the patient that his behavior was inappropriate and that he needed to cooperate to allow us to help him. The physician’s attempts to reason with the patient were only met with further curses and racial slurs. Ultimately, the patient was restrained and sedated so that we could attend to his injuries. When we reentered the room, we found him lying unconscious, intermittently groaning under heavy sedation. We proceeded to suture his wounds. In contrast to his previous aggressive demeanor, he now appeared pathetic and helpless. Any anger from our previous encounter had dissipated. Earlier, I had struggled to foster empathy while witnessing his abuses, but now, as he lay in restraints with torn clothing soaked in blood and dirt, I was suddenly overcome with feelings of guilt. I tried to imagine the circumstances that might have contributed to his current state. Despite our similar ages, I thought about how different our lives had been, about the privileges that I had enjoyed that he may have lacked. I felt guilty for my initial reaction, for having been angry, for judging him. This episode made me reflect on the challenge of remaining professional, especially in extreme situations where intense emotions and stress can cause us to forget the virtues of ethical practice and to revert to baser reactions. Being a physician certainly demands a high standard of ethical behavior. Nevertheless, this standard of professionalism does not necessarily entail a stoic notion of perfect equanimity. We all have human reactions and trying to eliminate these altogether, I believe, would harm our clinical practice. Just as anger and aversion can negatively impact patient care, joy, hope, and sadness can be harnessed to make for more meaningful doctor–patient relationships. This experience taught me that being a professional does not necessarily mean erasing all the negative emotions that one might feel. Instead, it involves developing the capacity to reflect on and to counteract initial reactions, recognizing how such feelings can adversely impact patient care. One strategy that helped me in this case was a deliberate and self-conscious attempt to foster empathy. The patient and I were, after all, not so different in age, perhaps separated only by luck and circumstance. As I continue in medicine, I hope that this experience will leave me better equipped to deal with these situations in a way that is not only professional but also human. Acknowledgments: The author wishes to thank Dr. Chris Willer, Dr. Sheena Taylor, and the student members of his Portfolio group for fruitful discussions on professionalism in medicine. He also wishes to thank the anonymous Faculty Scholar who provided feedback on this reflection and encouraged him to submit it for publication. Benjamin Chin-Yee, MA

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