Table 7.
Physicians’ emotional responses to conflict
| Leading up to initial decisional meeting |
| Emotional distancing: “One thing I do before family meetings is increase the ‘clinical detachment factor’ because some of what comes up in meetings is so raw that I probably put walls up and say, ‘I don’t have feelings.’” (Physician 3) |
| Anticipatory anxiety: “Before all family meetings, I’m nervous and apprehensive, burdened by the weight of the huge decisions being made.… [S]ometimes I even procrastinate a family meeting because it’s so uncomfortable for me.… I fear that I’ll contribute to the family’s distress or that there’ll be some standoff or disagreement. There’s awareness that what I’m doing in the meeting is going to have really lasting repercussions, feelings, and memories for a lifetime for the individuals in that room. That’s a heavy burden.” (Physician 5) |
| After family meetings in which there is conflict |
| Sadness and regret, drained |
| “Family meetings usually don’t go exactly as planned, and I screw up often and regret things I said and the way the meeting went or how I handled situations.” (Physician 5) |
| “A lot of times when I come out of a meeting I feel really drained, like exhausted, and sometimes kind of sad and also this kind of tension between having this very emotional response and then having to go to the next thing, if it’s a busy day.... I let myself feel it for a few minutes, then I pack it away, you know. There’s this kind of very pragmatic moment of like, ‘Okay, now I can move on.’” (Physician 9) |
| Frustration |
| “At times I feel frustrated; often this happens if I find the family is just not getting it and they’re completely unrealistic in what they’re thinking, and no matter how I’ve presented it to them or had other people try to present it to them, they’re just not getting it.” (Physician 6) |
| Anxiety |
| “I get just as anxious when I feel as though I’m trying to convince them to withdraw care. If I go in there and after the conversation, they say, ‘Okay, we should withdraw care,’ I sort of feel as though that’s been my decision and that also is a little anxiety provoking.” (Physician 11) |
| Satisfaction, relief |
| “I’m very happy if it’s a successful meeting, which means that you communicate what you want to communicate to the family, so that the family actually understands that the patient is ill, the chance of meaningful recovery is very small; if they understand that, at least I will be very happy.” (Physician 10) |
| “I often feel relief after a meeting if we’ve been able to come to a decision that I think is the right decision for the patient, meaning I think it’s going to allow them to die with dignity.” (Physician 12) |