Matt Morgan: When nothing is the right thing to sayBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m574 (Published 18 February 2020) Cite this as: BMJ 2020;368:m574
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Sitting too long in the rubble: Students must know to seek advice after experiencing death for the first time
We were touched by Dr Morgan’s powerful parable on the importance of our response as healthcare professionals to the grief of patients’ relatives. Yet, as students, we have felt wholly unprepared when witnessing death and grieving patients for the first time. We feel more could be done to prepare us for such challenges.
In our centre, 23.1% of all medical students have experienced a personal bereavement during their course (1). Medical educators are aware of such pressures and are trained to deal with them appropriately, but experiencing death and bereavement in a clinical setting poses an entirely different set of problems for students.
Experts in physician wellness acknowledge that “the death of patients is an experience that almost all physicians must confront” (2), yet, anecdotally, after experiencing death ourselves as clinical students involved in unsuccessful resuscitations, medical staff in emergency departments are often, if understandably, too busy to offer the opportunity to “debrief” with a junior.
Dr Morgan’s insightful comments regarding the seemingly hopeless task of comforting bereaved relatives are echoed by Pessagno who notes that, for medical students “dealing with family members of the dying was often as challenging as dealing with the dying themselves”. Interestingly, she also finds that the subsequent support of attending physicians towards their juniors constitutes a crucial factor in the way we process and learn from these events (3).
As students, we receive training in following patients and their relatives through the final stages of their lives: breaking bad news, comforting loved ones, and preparing for the range of emotions we might encounter. We are taught that communication in palliative care is not intuitive, that we must practice and reflect on how we communicate, being prepared to make mistakes in the pursuit of becoming more competent care givers. The often abrupt nature of loss in an emergency setting creates situations this training can rarely prepare us for.
We believe that more could be done to encourage students to seek a “debrief” after experiencing loss – a discussion we ourselves weren’t aware to ask for, but have sought in similar situations ever since and been highly grateful to receive.
1. Whyte, R., Quince, T., Benson, J., Wood, D., & Barclay, S. (2013). Medical students' experience of personal loss: incidence and implications. BMC medical education, 13, 36. https://doi.org/10.1186/1472-6920-13-36
2. Kvale, J., Berg, L., Groff, J. Y., & Lange, G. (1999). Factors associated with residents’ attitudes toward dying patients. Family Medicine, 31(10), 691–696.
3. Pessagno, R., Foote, C. E., & Aponte, R. (2014). Dealing with Death: Medical Students’ Experiences with Patient Loss. OMEGA - Journal of Death and Dying, 68(3), 207–228. https://doi.org/10.2190/OM.68.3.b
Competing interests: No competing interests