title: What keeps you up at night? Genetics professionals' distressing experiences in patient care.
abstract: OBJECTIVE
  To explore specific patient care experiences that genetics professionals associate with distress and the emotions engendered by those experiences.
  
  
  METHODS
  We conducted semistructured telephone interviews with clinical geneticists, genetic counselors, and genetic nurses that focused on a single distressing experience.
  
  
  RESULTS
  Fourteen clinical geneticists, 25 genetic counselors, and 14 nurses were interviewed. We categorized the situations that interviewees associated with distressing patient care experiences into seven major types: patient/family decisions (27% of total situations), giving bad news (17%), colleague behavior (15%), end-of-life issues (12%), unintended outcomes (12%), difficult patients (8%), and injustice/inhumanity (8%). Interviewees reported experiencing a variety of negative emotions during these situations, including anger, guilt, helplessness, and inadequacy.
  
  
  CONCLUSIONS
  The distress and resulting emotions experienced by genetic service providers must be acknowledged. Interventions are needed to assist the clinician in becoming self-aware by reflecting on experienced emotions, examining belief systems and values, and understanding the connection between their emotions and behavior. Involvement in mindfulness meditation, reflective writing, peer support groups or additional communication skill-based training could address this need. In addition, clinicians should seek ways to increase personal meaning derived from providing patient care.
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. Barbara.bernhardt@uphs.upenn.edu
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Bernhardt
authors.forename: Rachel
authors.initials: R
authors.lastname: Silver
authors.forename: Cynda Hylton
authors.initials: CH
authors.lastname: Rushton
authors.forename: Ellyn
authors.initials: E
authors.lastname: Micco
authors.forename: Gail
authors.initials: G
authors.lastname: Geller
mesh_terms: D005190:Family / Q000523:psychology*; D033142:Genetic Services / Q000706:statistics & numerical data*; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D009726:Nurses / Q000523:psychology; D005791:Patient Care; D010820:Physicians / Q000523:psychology*