• patient satisfaction
• mental health
• patient safety

A few months ago, I received feedback via email from our patient experience office. Among other concerns, the parent of a patient I had cared for felt as if her child left the emergency department (ED) no better than how she had arrived, that she needed more help than I provided, and that I seemed ‘overwhelmed’ by her child’s issues.

As I read the complaint, I could feel my heart rate start to quicken, my jaw set, the butterflies in my stomach wake up; this was my body sensing a threat, readying to fight. In his book Emotional Intelligence, Dan Goleman calls this an ‘amygdala hijack.’1 The purpose of the amygdala is to sound the alarm and prepare us to fight or flee. Research using functional MRI demonstrates that the strong negative emotions produced by criticism activate the amygdala, shutting down the neural pathway to our prefrontal cortex and invoking ‘cognitive, emotional, and perceptual impairment.’2 Complex decision-making disappears, along with our ability to consider others’ perspectives.

In my amygdala fog, I thought this mother didn’t understand the complexity of caring for her daughter’s problem; that the resources I offered were the only ones we had available; that I called multiple people to help her; that she was just ungrateful.

This was immediately followed by the arrival of my critical inner voice (whom I’ve named Reese Witherspoon): ‘Another physician would have handled this better’; ‘You should have spent more time with her’; ‘You don’t have the kind of empathy you need for this job.’ Even when my heart finally slowed, and I got blood back to the rational parts of my brain, this voice stayed with me for days, keeping me up at night, spinning and respinning the comments around in my head.

Most physicians I speak …