Intended for healthcare professionals

Letters Covid grief has cracked us open

Covid grief: medical examiner’s office could be central point of access for counselling and support services

BMJ 2021; 374 doi: (Published 29 September 2021) Cite this as: BMJ 2021;374:n2378
  1. Alan J Kevern, consultant in acute medicine, medical examiner in bereavement services
  1. Frimley Health NHS Foundation Trust
  1. alan.kevern{at}

The covid-19 pandemic has shaken the lives of every person in virtually all aspects. We should take a moment to reflect on the impact it has had on all aspects of death, too.

Working as medical examiner during the pandemic has been a career milestone. I have painful memories of piles of notes on my desk, each with a death certificate clipped to the front with the words “covid-19” written clearly at the top. The experience was overwhelming.

The medical examination process involves having a conversation with the deceased’s next of kin to explore concerns regarding care. Common themes, as discussed in Selman’s article,1 were all too prevalent, including visiting difficulties (sometimes only permitted in the last few hours of life, if at all), communication barriers, and anger that covid could have been acquired in hospital.

I strongly agree with Selman’s statement that as clinicians we have an important role in supporting family and friends before death and that we also have an invaluable role in maintaining that support after death. The bereaved need a central point of access to the extensive counselling and support services available in the community. I worry that knowledge of the breadth of available support and the grieving process is lacking among clinicians. For relatives of those who die in hospital, the medical examiner’s office seems to be the ideal source for that information and signposting. Early steps to improvement could include more extensive training for medical examiners and officers.

Perhaps in the future the medical examiner’s service could expand to include formal bereavement counselling clinics and opportunities for the bereaved to discuss their feelings, express concerns, and ask further clinical questions beyond the remit of the often all-too-short telephone conversation we currently offer.