Death is part of a doctor’s job
BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5597 (Published 31 October 2016) Cite this as: BMJ 2016;355:i5597
Abstract
Doctors should not be afraid to seek help if they are struggling after the death of a patient, says Marika Davies
Doctors are used to dealing with death. While they may never forget their first experience of a patient dying, they soon become accustomed to death as a part of their working lives. Achieving a balance between retaining compassion and staying detached enough to be able to do their job is one of the attributes that a doctor must develop and maintain.
But at any stage of their career, a doctor may be particularly affected by the death of a patient. Last year, a photo of a doctor crying after the death of a young trauma patient was shared on social media and was a poignant illustration of the grief that a healthcare professional can feel.1
Doctors and death
Doctors may be affected by the death of a patient they knew well, or because of the circumstances surrounding the death. They may have associated feelings of self doubt, helplessness, guilt, or failure, or they may be worried that they will be criticised for their involvement in the patient’s care.
In a study of oncologists in Canada, researchers found that grief was considered shameful and unprofessional.2 Doctors in the study said they wrestled with feelings of grief, but hid those feelings from others because showing emotion was considered a sign of weakness. The researchers reported that the impact of the unacknowledged grief was inattentiveness, impatience, irritability, emotional exhaustion, and burnout. They concluded that the professional taboo around grief had negative consequences for doctors, as well as for the quality of care they provide.
A patient’s death can also impact on a doctor who is already experiencing difficulties and is struggling to cope. It can be a particular concern to a doctor who is already under investigation by their employer or the General Medical Council (GMC), as they may be anxious that the death will attract further scrutiny and criticism.
After the death of a patient, a doctor may need to prepare a report for a significant event investigation or the coroner, or attend an inquest as a witness. The family may make a complaint, take legal action, or refer the doctor to the GMC. Even the possibility of these events will cause stress and anxiety for the doctor. Relatively simple administrative tasks such as the completion of death certificates or cremation forms, or a request for the disclosure of the medical records of the deceased can be an additional demand on the already pressuriseed doctor.
Coping with death
Dealing with death is often difficult, no matter what the circumstances, and doctors develop ways of coping during their career. The oncologists in the Canadian study described the use of compartmentalisation—the ability to separate feelings of grief about patient loss from other aspects of their lives and practice.
In a recent bulletin of the American College of Surgeons, doctors shared strategies that they had learnt to ease the difficulty. These included making contact with the patient’s family and talking to someone they trusted after a loss, such as a family member or fellow doctor who could help them see the situation objectively.3
Ranjana Srivastava, an Australian oncologist and author, writes positively about the grief that doctors feel, which she says can be a catalyst for improvement. “Being a doctor is emotionally punishing, but connecting with our patients as fellow human beings is what renders it not merely a job, but an incomparable vocation,” she says.4
Death is an inevitable part of life and this is particularly true for doctors who must deal with it on a regular basis. But occasionally it can have a negative effect on the mental health of doctors, who should not be embarrassed to seek help when they need it, and to make use of the counselling services that are available. Any doctor can be taken by surprise by how they are affected by a death and should know that it is entirely acceptable to feel this way.
Footnotes
Competing interests: I have read and understood BMJ’s policy on declaration of interests and declare the following interests: none.