Uh oh. Your patient is crying. What to do? What to do?

(1) Do not reflexively refer the patient to a psychiatrist.
(2) Do not reflexively refer the patient to a psychiatrist.
(3) Do not reflexively refer the patient to a psychiatrist.

That hasty referral sends the message that (1) it’s not okay to cry, (2) I don’t want to see you cry (or I can’t tolerate seeing you cry), and (3) there must be something wrong with you since you are crying. (”Not only do you have Medical Condition X, but you might be mentally ill, too!”)

Crying can be a completely natural and expected response to information. Furthermore, there is variation in how people respond to news; some express more overt emotions than others. You also don’t know what else is going on in the patient’s life; sometimes your news is actually the single straw—as unremarkable as it may be—that, according to the proverb, breaks the camel’s back.

“But! But! But!” you may protest. “I know all of that, but I just don’t have the time to deal with that kind of stuff! I don’t want to ask more about it and then open the floodgates and have this person bawl in my office for hours and hours. I’m not a therapist; I’m a doctor. My job is to take care of the patient’s (uterus, blood pressure, alcohol use, diabetes, whatever)!”

Ah ha. You and your patient don’t share the same agenda.

Well, part of your job is to help comfort the patient. Although curing disease may seem like the primary function of medicine, the reason why we try to cure disease is to maximize quality of life and optimize function. We don’t encourage people to stop smoking “just” because we want them to stop smoking; we encourage them to stop smoking so that they can breathe easier for as many years as possible and minimize the development of other conditions like emphysema, COPD, and lung cancer in their futures, which, as you know, will (likely adversely) affect the quality of their lives. Although medicine has made some remarkable advances, we can’t cure everything and sometimes, the best thing we can “do” is offer comfort. Additionally, comfort in of itself can maximize quality of life; there’s something about sharing a burden with someone else that can make life seem less laborious and more tolerable.

So your patient is crying and you can’t cure crying. You’re astute, though, and realize that the crying means something. In our culture, crying is not embraced and, in the vast majority of cases, if someone is crying in front of you, s/he is significantly distressed and is trying not to cry. (Think of all the people who have apologized for crying, as if it is something to be ashamed of.)

Yes, it can be hard to see people cry. It’s uncomfortable. There’s that strong urge to make them stop—because if they stop crying, that must mean they feel better, right? Then there’s the fear that we are the ones doing something that’s causing them to cry (is it always about us?). Or the fear that they will continue to cry forever and forever (see above).

Contrary to popular fears, crying does not last forever. The emotion that underlies crying will also not persist forever. That emotion may not disappear completely, but it will abate enough so that the individual will eventually stop crying. This doesn’t even take into account the social pressures we experience to refrain from crying in public (see above). Remember these points.

You don’t have to do anything if your patient is crying. Sometimes, the best course of action is to just be with the patient. The gives the message that (1) it’s okay to cry, (2) I’m not going to freak out just because you’re crying, and (3) maybe the best response to the situation is to cry.

“But! But! But!” you protest again. “You’re not listening! I don’t have the time to deal with that kind of stuff! I habitually run late and I’ve got all these other patients waiting for me! What am I supposed to do?”

Suggestions:

(1) Acknowledge the situation in a calm manner. Please note that this does not mean that you should bluntly describe the situation: “You are crying. I don’t have time to be with you while you cry.” Just because you’re pressed for time does not give you the license to lack civility. Try: “This is understandably upsetting. I’m afraid that I cannot spend the time with you that I’d like to due to the clinic schedule.” Your overt recognition of the situation acknowledges the patient’s experience. Sometimes, that in itself can be healing. People don’t like to be ignored.

(2) Communicate that you are concerned about the patient and, though there may be nothing you can do to “fix” the situation, you would like to offer what you can. That “something” can be a modified version of “being” with the patient. If you are in an inpatient setting, you can offer to visit the patient again later on in the day to briefly check in on how s/he’s doing. If you’re in an outpatient setting, you can offer to the patient the opportunity to wait in the waiting room until s/he feels calmer and then you can briefly pop out to check in on how s/he’s doing between patients. Or you can offer to call the patient in a day or two to check in. Please note that these are just “offers”. Don’t foist yourself on patients; some people are already feeling mortified about crying in front of you and don’t want reminders that they committed this heinous act. Some people may seek comfort in other places and people. And, to be sure: Make sure you actually do these things if you say you’re going to do them. People like integrity.

(3) Ask the patient what would be most helpful in that moment. If you don’t know what to do, ask for help. You can qualify this statement with something about your packed clinic schedule if time is slipping away from you. This inquiry communicates that you respect the patient’s opinion, that this is a collaborative effort, and that you want to help. It is the rare patient (or human being, really) who will scowl at you and bark, “Well, you’re the doctor, you should know!” in response to that question.

For most physicians, a crying patient is a low-incident event. This partially explains why doctors may feel as uncomfortable as they do when a patient does cry during the appointment. This occasion, however, need not instill fear: This can be a grand opportunity to heal, even when you cannot cure.