Table 2.

Fifteen types of situations eliciting intense emotions in daily practice from 122 physician survey respondents^a

Categories of situations	n (%)	Indicators
Health deterioration/death	35 (28.7)	I watched a patient die before the medical team’s powerlessness and anguish. The patient was conscious ] and we could tell by his facial expression that he could understand what was going on. He tried to tell us something but it was not perceptible
Physical or psychosocial suffering	14 (11.5)	I followed-up with a patient in the intensive care unit. She was young and suffered from severe systemic lupus. She had a tracheostomy and was ventilated but conscious. In one of the medical visits she asked me for a paper and wrote, “Help me.” She was in very bad shape and eventually died.
End-of-life patients	13 (10.7)	She was a terminal patient receiving comfort measures in the intensive care unit. For four years I could never get her to accept her illness and start treatment. I felt frustrated watching her die and could not do anything. Then, she grabbed my hand and looked at me in a way I will never forget, and smiled. I felt that her look meant, “It was my fault, you did everything you could. I am in peace.”
Aggressive patients	11 (9.0)	During a consultation a patient pointed a gun at himself. In the ER the family of a patient invaded my office and threatened me because I was taking too long to see her .… I felt very vulnerable around them all. They were threatening to destroy everything, using inappropriate language, hitting the wall, and dropping material that was over the desk.
Communicating bad news	11 (9.0)	Having to tell a young patient that her husband and children died.
Solving the patient’s problem	8 (6.6)	The first time I alone diagnosed and successfully treated a patient in the ER. A patient who was amazed about the surgery that restored his sight.
Patients’ rudeness	7 (5.7)	While I was with a patient, his wife spent the entire time reading the newspaper. I felt disrespected.
Unexpected disabling condition	7 (5.7)	A young patient entered the emergency room in cardiac arrest. She was alone at that moment without any family members who could provide any information. After two cycles of advanced life support, she recovered. When we could collect a clinical history, we found out that she had terminal brain cancer.
Accusations of malpractice	7 (5.7)	During a consultation, a patient confronted me with the desire to have a routine examination check for everything, and about my obligation to do it. He said, “I have paid taxes for many years and now I have the right to have the exams I want. Nowadays, doctors study medicine for money. In the old days, we had good doctors that did the exams we wanted.” A family member of a patient I had seen the day before came to tell me that the patient died on her way home. He criticized me for not sending her to the emergency room instead.
Disagreeing about the proposed treatment	4 (3.3)	The team told a patient’s family that he would die and that the situation was inevitable. I believed that a bigger effort on our part could still save him.
Patient telling disturbing information	1 (0.8)	I felt repulsed after a patient mentioned that during an impulsive episode she killed her pets.
Making harmful decisions	1 (0.8)	A patient asked me for a compulsory detention of her mother, who took care of a bedridden brother. This brother would be abandoned for lack of social and family support.
Stress at work	1 (0.8)	Stress in the operating room.
Demanding patients	1 (0.8)	Following-up a patient with a personality disorder. She questioned every medical intervention, saying nothing was working. She had multiple complaints and was very demanding. Dealing with her husband’s pressure (“You have to make her better”).
Patients’ gratitude	1 (0.8)	A patient’s widow offered me a reminder of her husband, who had died three months earlier. I never met him, only supervised some aspects for his well-being during his palliative phase.

^aIn this particular question only 122 physicians answered; 2 participants reported the emotion but not the situation that elicited it.

ER = emergency room.