How I Feel Affects My Decisions & Patient Care

     "Historically, the prevailing view in medicine is that clinical decisions should be objective and free from contextual affective issues: one could not be objective and rational if emotion entered the reasoning process. Indeed, many of us would consider it a professional virtue to be able to rise above the emotional pull of clinical situations, to deliver cool, clear, analytical judgments. However, despite what we might believe, our feelings (affect) intrude into almost every decision that we make. Our daily interactions with others are influenced by conscious or unconscious social transference phenomena which are affectively polarised in ways that range from subtle to substantial. Similarly, specific clinical situations provoke lesser or greater degrees of affective valence. In fact, our first response to anything is an affective one that governs the future direction of our relations — we tend to trust our first impressions and stick with them. To then understand the role that affective state has in clinical decision making seems important. 

     The best evidence might be degraded when it is unconsciously passed through an affective filter."
       Croskerry P, Abbass AA, Wu AW. How doctors feel: affective issues in patients' safety. Lancet 2008; 372(9645): 1205-6. 


     "Within mindfulness, the busy physician may find a practical place to begin. Through the cultivation of mindfulness, the busy physician can find clues to the self and to the other, as well as to the aspects of inter-being that not only set the intention of the medical encounter but also provide boundless information and the basis for right action."
       Physician, Know Thyself, Michael Krasner, Shambhala Sun, September 2007.

 

snellius   www.dpreview.com

Self-conscious Emotions: Shame & Guilt, and Basic Emotions: Anger & Anxiety

     "Shame, which may be the more painful emotion, is characterized by feelings of being small, worthless, powerless, exposed, and inferior. Shame generally facilitates action tendencies geared toward escape or withdrawal. Individuals in a state of shame often report a desire to hide, a finding that underscores the notion that an actual or merely perceived condemning audience is central to the shame experience. Guilt, on the other hand, involves tension, regret, and remorse over the effects of one’s negative behavior on other people. The pain of guilt may be more tolerable because, as mentioned previously, the global self is spared from devaluation. Guilt is characterized by an approach-and-amend strategy that facilitates reparation, confession, and apology.  

     ... the affective tone of self-conscious emotions (eg guilt & shame) can be altered by any of several basic emotions that are experienced concurrently. There may be an especially tight link between shame and anger. Although internal attributions for events are required for the initial elicitation of shame, some individuals appear to cope with the painful affect of shame by shifting blame for untoward outcomes to external agents, a tendency that may lend itself to the experience of anger. ... anger and shame (may) represent complementary responses to social threat. In this view, anger is the dominant response, whereas shame is the submissive response. Shame or guilt may also become infused with anxiety. The actual or perceived public exposure inherent to shame seems to suggest an obvious link to social anxiety, in particular. Finally, there may be a connection between disgust and shame. Whereas disgust involves the rejection of an offensive object, shame may be regarded as involving the rejection of an offensive self. Indeed, it has been argued that disgust is the foundation of shame." 

       Kim S, Thibodeau R, Jorgensen RS. Shame, guilt, and depressive symptoms: A meta-analytic review. Psychol Bull 2011; 137(1): 68-96.

     See also: http://mindfulnessforeveryone.blogspot.ca/2013/04/308-guilt-vs-shame-self-conscious.html
     and: http://mindfulnessforeveryone.blogspot.ca/2013/04/309-release-ancient-fears-remember-to.html
     and: http://healthyhealers.blogspot.ca/2013/04/misbehavior-inappropriate-shame.html