Anne Gulland: Is it okay to cry in front of patients?

Anne_GullandThis was a question I put to members of doc2doc, The BMJ’s community site. The idea was sparked by an obituary (yet to be published) of a respiratory physician who told a junior colleague not to be embarrassed to display a “red eye” to patients from time to time. As I considered this doctor’s words I came across an article in The BMJ by James Munro, the founder of Patient Opinion, who wrote that a mother told him she was comforted by the tears shed by doctors and nurses after the death of her daughter.

Out of the 528 people (at the time of writing) who voted in the poll, 326 people ticked the option that said yes, it was okay to cry in front of patients, depending on the situation. A further 65 people voted yes, expressing emotion is good. And a quarter of those polled, 138 voters, said that doctors should not cry under any circumstances.

The comments below the poll suggest that doctors feel that a quiet tear is acceptable but not outright sobbing and wailing. Anything that makes the patient feel uncomfortable or distressed is taboo.

DrS sums up the feelings of many correspondents: “I recall being told by a consultant that it’s okay to cry, as it shows the families that we care. But never lose control such that the family feels the need to comfort you when their emotion should clearly have priority.”

For those 326 who voted that it was okay to cry under certain circumstances, maybe discreet tears show empathy or humanity, rather than betraying weakness or vulnerability.

However, others had different views. RaghuCardio says doctors’ tears were mere “dramatisation.” “A doctor should always keep his [sic] emotions separate from the patient,” RaghuCardio wrote. “Patients expect solutions and courageous words from doctors. Doctors need tact, experience, and training to overcome these situations,” s/he adds.

Pat Harkin agrees that doctors should not cry in front of patients, concluding: “We should empathise with our patients but I don’t think we should suffer with them.”

Sidhom, a psychiatrist, points out the difference between empathy and sympathy, saying that the first is a necessary trait for doctors, but the second is dangerous in terms of confusion to patients and burnout to therapists.

But what do tears mean anyway? Some people can cry at anything (even the John Lewis Christmas advert for goodness sake!), while for others tears do not flow so easily.

According to research, women cry more than men—perhaps no surprise. People who are more secure are also more likely to feel comfortable expressing their emotions through tears and cry appropriately (that is, they can be more easily soothed). However, those with less secure attachments are more likely to cry inappropriately and harder. There is also little research to back up the theory that “having a good cry” is in any way cathartic. [1]

Doc2doc has many international members but, having pondered this, it all sounds very British—we may be losing our stiff upper lip, but we want to retain some decorum.

[1] Collier, L. Why we cry, Monitor on Psychology, February 2014, vol 45, no 2.

Anne Gulland is currently community manager on doc2doc.

Competing interests: None declared.