Oh, Good, I’m not a sociopath

I’ve got that doctor ability to see pain, treat pain, occasionally inflict pain for the duration of a treatment, but not let it affect me on any emotional level. Some would think that’s sociopathic. Good, news, it’s a learned trait:

Doctors control emotions with patients

CHICAGO, Sept. 27 (UPI) — A U.S. study suggests physicians shut off the portion of their brain that helps them appreciate the pain their patients are experiencing.

Because doctors sometimes have to inflict pain on patients as part of the healing process, they also must develop the ability not to be distracted by the suffering, said Jean Decety, a professor of psychology and psychiatry and co-author of the study.
“They have learned through their training and practice to keep a detached perspective; without such a mechanism, performing their practice could be overwhelming or distressing, and as a consequence impair their ability to be of assistance for their patients” said Decety.

The research that included the use of functional magnetic resonance imaging brain scans shows for the first time that people can learn to control such a response….

I’m not as nice as I could be, but I’m not a bad person.


  1. You cold-hearted bastard.

  2. Cool. I know I go into “the zone” too when there’s something very stressful going on. Patient may be having a 10/10 massive MI, going pale, look of dread on his face, sweating, moaning, and my face goes blank and I just start doing lines and drips and nitro and morphine…Pretty much no emotion.

    But if there is someone on TV who tragically dies, I’m a crying mess. It’s weird.

  3. I go into the ‘zone’ too while I’m working with the patients that are experiencing something horrific. I don’t think I could function otherwise. My mother actually discouraged me from becoming a nurse because she didn’t think I could handle having to witness people suffering. The zone helps us focus on what is causing the distress rather than the distress, then we can actually do something about it.

    That’s not to say that there haven’t been times when I have felt completely overwhelmed by the horrible things that people can do to each other, or themselves. I have prayed with patients and families, I have hugged and wept. Some people may see that as weak, but I have never had a family say ‘I wish I couldn’t see that you care.’

  4. And for this they need research? How can we get some of the money? Maybe you, me Nurse K and Mudme can do a focus group?

  5. Paramedic Tim says:

    I can’t say I go into ‘the zone’, it still bothers me a little after 11 years.
    I rather think of it as an acquired tolerance to the nasty stuff. Oh, and I find it’s good to cover yucky stuff with multi-trauma dressings.

  6. I guess I’m not alone. Before I went to medical school, I had a medic friend who was worried that someday, all the blocked out stuff would erupt because it just didn’t phase him at all. So far, seven years later, he hasn’t. he still loves it. Doesn’t bother me much either except when I can identify with the patient, like someone who reminds me of my parents, grandparents or nephews.

  7. As an Orthopod who takes Level I trauma call and as a father of 3 I simply can not separate myself from the emotion of seeing a parent anguish over their child who just got whacked in an MVA.

    Maybe dealing with the adult population is different, but I still find myself identifying with most patients on some level. I suppose that if I dealt with this on a daily basis, hour after hour it might be different. I’m lucky I only take call 4-5 nights per month.

  8. It’s called “clinical detachment,” and in my opinion, those who don’t develop some degree of it don’t last long in any sort of trauma-based specialty. You can’t go all to pieces over one patient, because there’s another one just like him/her rolling in the door right behind them.

    It’s a survival trait, and only a non-initiated layman or complete trauma newbie could fail to see the utility of it.

  9. Being able to take the Subjective component and the Objective portion of an H&P and put them together to fix what’s broken is what makes medical/trauma providers unique in a world of the exquisitely squeamish and emotionally attached.

    We have to be able to distance ourselves to get the big picture and do what it takes for a good outcome.

    It’s not being cold–it’s doing the job

  10. does this phenomenon exist in other forms of practice, say, psychotherapy? i have found that when a patient is talking about sexual abuse and the discussion is obviously causing emtional pain, i don’t shut down. perhaps this “zone” med docs experience is associated with physical pain and visual trauma.

  11. P.A. student-Nas says:

    Those of us in a trauma based specialty develop what is called a “trauma barrier,” and is necessary to our mental health. A trauma barrier is an adaptation we develop, something that allows us to withstand horror and horrific images while maintaining good mental health AND the ability to keep doing what we do. Critical Incident Stress Management is also necessary at times, when faced with something particulary gruesome. We do not have stone hearts. We simply have developed survivor mechanisms. Here’s a big pat on the back to my colleagues!!

  12. I try to ride the line between. I try to feel sorry and empathise some with them, but in the end, you have to do your job and are able to understand that you can only make things worse if you do not do your job well. I don’t want to add insult to injury when I treat people. That puts a whole lot of pressure to do a good job – fortunately we docs are good under pressure.

    I do think we need to somehow show compassion even when we are not letting the emotions wreck us.

  13. When I ruptured both my ACL and PCL and fractured the head of my fibula while hiking this ability may have saved my own life. My left foot had gone forwards ending up about 10″ from the front of my right shoulder. As I was gently pushing my leg back down in hopes of saving it and me, when I was about to pass out from the pain, a ‘loud’ thought popped into my mind, “You can’t pass out – you’re the only doctor here!” While true this also struck me as slightly humorous. I did not pass out. I believe my ability to dissociate from pain that I learn in medical school and while working in urgent care for about five years, saved my life and my leg. My leg is now fully functional after an airlift, reduction, fem-pop bypass and ACL/PCL repair. I’ve been back hiking again.

  14. Sarah B. Dougherty, PsyD says:

    I think what you are describing is the ability to manage ones own emotional response in order to accomplish a larger goal that is in the patient’s best interest. Entering the “zone,” as it has been described here, is a coping mechanism that develops from desensitization (you’ve seen lots of blood and guts and pain) COUPLED with the knowledge that you are doing what you have been trained to recognize as helpful and necessary to the sufferer. If other people’s pain doesn’t bother you because you are more interested in your own selfish needs, that’s sick. (Self-defense does not apply here.) If you get some sort of “rush” from seeing or inflicting pain, that’s sicker still.