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Coping With Loss

BMJ 1999; 318 doi: (Published 16 January 1999) Cite this as: BMJ 1999;318:200
  1. Mari Lloyd-Williams, senior registrar in palliative medicine.
  1. LOROS Hospice, Leicester

    Ed Colin Murray Parkes, Andrew Markus

    BMJ Books, £14.95, pp168

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    ISBN 072791068X

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    Doctors have largely replaced the village curate as the confidante of their patients' sorrows. Feelings of loss and the resulting distress—be it through bereavement or the break up of relationships —are therefore encountered more frequently by doctors. But how well equipped are we to deal with such patients, and how do we know when we have reached the ceiling of our competence? How do we cope with the continuous emotional pain of others and the pressures of working in an increasingly litigious society without burning out?

    Coping with Loss addresses these and other issues. The major loss most often encountered is bereavement. The concept of bereavement as an adaptation to a different life while cherishing the memory of the person who has died—rather than a process with a defined beginning and ending—is being developed and becoming accepted, and there have been an enormous number of books published in the past decade on this subject. As with all loss, being prepared for what may happen can alleviate some of the pain and distress. It is still often the case, for example, that children are rarely prepared for the death of a parent or sibling and are excluded at the time of a death—factors that can lead to complicated grief and psychiatric morbidity in later years.

    It is refreshing to read a book covering both bereavement and other losses—including those rarely covered, such as loss of sensory and cognitive function—and which emphasises the important role that doctors have in supporting patients through the time of loss and change. It gives much useful information on how to elicit and discuss sensitively patients' fears and griefs, guiding the reader on what may be appropriate and what may warrant further assessment or referral. Although the focus of the book is on primary care, the information is equally applicable to all medical and health workers. Clinical governance and the wellbeing of doctors are highly topical; Glin Bennett's wise and philosophical chapter considers the role of doctors in supporting colleagues and in looking after themselves and makes the point that even the most distressing losses can be a source of growth and renewed strength.

    I value this book; it is well written and expertly edited and is consequently very readable. Coincidentally, the evening before this book arrived, I had been out for a meal with the parents of a friend who had died five years ago. A deficit in this book is that it does not address the difficulties of parents who lose an adult child, and this major loss is one that health professionals do not always acknowledge.

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