How Do Physicians Handle Grief?

At some point in your medical career, you may face the death of a patient. Despite its widespread phenomenon in medicine, the experience is still overwhelming every time. However, the emotional aftermath that physicians deal with in regards to patient deaths are rarely discussed. As a physician, you spend so much time treating the human body and focusing on patient care that thinking about subjects such as grief may be placed on the back burner. So, when the time comes, how do you deal with grief? Each physician has his or her own psychological methods as to how to process patient loss. Some physicians handle grief by voicing their feelings, while others handle grief by becoming numb. Some write down their feelings of their time spent with the patient in an effort to celebrate his or her life, while others express a morbid sense of humor as a defense mechanism to mask their true feelings. Needless to say, there are several ways to address grief and you must identify your personal style when it comes to processing patient loss.

Yet, why is doctor grief so important? Patient deaths affect a large percentage of healthcare professionals. Grief-related stress at a job and medical malpractice may accumulate and lead to physician burnout – an outcome that affects over 50% of all physicians. A recent study, involving the participation of 20 oncologists, found that more than 50% of physicians struggled with feelings of self-doubt and failure after a patient’s death. What’s more, half of the participants reported distancing themselves as a patient got closer to passing away. The oncologists also reported that feeling this grief affected their ability to talk about the subject of end-of-life with subsequent patients and their families.

Learning to deal with and resolve such losses can ease some of the emotional baggage that physicians carry around with them. Here are some helpful ways in which you can handle grief and loss, as well as move forward in your career:

• Be honest with yourself and your patient’s family about what happened.
• Talk with a support group or colleague about the patient’s case.
• Express empathy to the patient’s family.
• Accept grieving as a natural part of the doctor-patient relationship.
• Accept the reality of loss and the negative outcomes related to your professional career.

As you advance in your medical career, you may develop an emotional detachment or coping mechanism to help deal with patient losses. Still, it is crucial that you go through loss and grief so that you can redefine your life’s work with meaning and hope.

• Express your feelings – You should not feel ashamed in allowing yourself to feel loss – it is a part of being human. “Let emotions happen, it makes you human and empathetic. It takes time to get over a death, and it is okay to remember those that have died,” said Kelly Dinnan, trauma and general surgeon.
• Identify your role – Society generally associates physicians with the term ‘healer’. This may lead you to feel as if your only job is to be able to cure patients and if you do not succeed, then you are a failure. “If you look at your role to cure always, you will always feel like you’ve never done enough,” said Dr. Knebl. View your role exactly as you want to and not just as society views you.
• Take a moment to reflect - Take a moment to reflect on your time spen with the patient. “Each of us have our own internal coping mechanisms. Find what’s going to work for you to handle that loss and to continue to be effective for your patients and families” said Dr. Janice Knebl, geriatrician and palliative care specialist.
• Accept the reality of loss – Your first instinct after losing a patient may be denial, particularly if the death was sudden. Talk with the patient’s family and friends and allow them some time to process the news. Together, you can help each other heal by moving past denial and into acceptance.
• Recognize your limitations – Remember that there are limits as to how much you can do to help patients. “It’s not just me who can’t cure the child, it’s modern medicine,” said Dr. Lisa Kopp, pediatric and adolescent oncologist. “Great physicians are self-aware and willing to speak up about uncomfortable topics,” said Dr. Dinnan.
• Combat the feeling of failure – There is nothing that you can do about a patient getting cancer or suffering from another chronic illness. Your job is to strive to help them get better. If a patient dies, it is only natural to feel as if you have failed as a physician, but you should combat this feeling. Instead, remember successful patient stories and lives you have saved throughout your line of work.
• Adjust to your environment – In a clinical setting, death is inevitable. After experiencing a patient death, it is only natural to question your skills and line of work. Adjust to your environment by talking to your family, friends, colleagues, and patients. It might be easy to put yourself down, but you would be surprised as to how many individuals view you as a hero.

Nowadays, several health institutions are beginning to recognize the importance of grief. They are using their resources to discover new ways that focus on a physician's well-being and healthy coping skills. “Literature, guidelines, and curricula are available to help navigate these devastating situations. There is a seemingly endless stream of advice regarding what to say and what not to say to a grieving family. In stark contrast, however, is the lack of direction when it comes to coping with our own grief associated with the loss of a patient. Instead, the hidden curriculum of medicine teaches us to distance ourselves and create protective boundaries. Feeling and displaying too much emotion is not only regarded as unprofessional; it is a sign of weakness. This attitude is unrealistic and harmful. Literature that explores physicians’ responses to the death of a patient is limited, but the work that exists is alarming. Physicians often experience feelings of guilt, powerlessness, self-doubt, isolation, failure, worthlessness, and despair after the death of a patient. Left unaddressed, these feelings can lead to increased distraction, medical errors and burnout” wrote Lauren Gambill, pediatric chief resident.

By giving yourself permission to grief, you can work through your feelings of failure, fear, and guilt. By expressing and addressing your grief, you can continue to open up your heart to educating, supporting, and coaching patients’ and families’ who need you. This is not only beneficial to you as an individual, but also to you as a professional. “As I sat alone, I reminded myself that the hollow in my heart would again be filled by good tidings and the gratitude of strangers. 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. Eventually I tracked my way back to the hospital to meet a young medical student. Brimming with enthusiasm, she asked what it was like to be a "real" doctor. Sometimes exhilarating, sometimes sobering, I truthfully answered. But the best thing about being a doctor was that you frequently went home with an insight that made you a better doctor tomorrow,” wrote Ranjana Srivastava, oncologist.

The lesson here is death is a part of a physician’s job and grief is unpredictable. You may be taken by surprise by how much a patient’s death has affected you, but you should know that it is completely acceptable to feel this way and you should not feel ashamed to seek help. Time, especially is in a clinical setting, does not heal all wounds. This is a continuous process that takes mind preparation, strong dedication, and a desire to help fellow beings. You are allowed to mourn and you are allowed to grief, but how you do so is your own decision.