Managing doctors’ grief following a patient’s death

AFTER a loved one’s death, families often go to their GP for explanations on cause of death, queries on whether the death could have been prevented, and reassurance that the symptoms and moods experienced during their grief are normal. Some may consult with their doctor for symptom management if their grief is prolonged.

However, while we receive a doctor’s support, we rarely consider that GPs can also be grieving their patient’s death.

Usually, the first death of a patient is a devastating and life-long memory for a doctor, as it brings raw emotions and a sense of failure regardless of the efforts made to save that life. This is particularly true if the death is unexpected, or if the GP has treated the patient and their family over many years.

Realising that a patient’s life is going to end soon could trigger intrusive thoughts about the patient and family and a doctor’s own overwhelming feeling of helplessness. It is not unusual for young doctors to be unprepared for the emotional distress they’re about to experience through their careers – diagnosing incurable illness, communicating poor prognosis, supporting a patient and their family at the time of broaching the news, and then at the time of the patient’s death. Doctors constantly have to put on a brave face when confronted with the death of a patient, yet also need to acknowledge the concerns of the relatives and friends, show compassion, convey their availability to counsel and guide them, and refer them to other relevant support services if needed.

And while there is literature on how we as doctors should communicate with the family of a dying patient, little is out there on how GPs are supposed to effectively cope with their own grief.

The death of a patient can be soul-destroying and a learning experience at the same time. Yet, throughout the medical training years, GPs are not generally or intensively taught how to accurately predict when a patient will die, trained for very long on how to tactfully deliver bad news, how to support families going through anticipatory grief, let alone prepare for dealing with the angst they will inevitably experience themselves.

Many colleagues opt for silently grieving, as they may feel that expressing themselves could be a sign of weakness or lack of professionalism. However, this unresolved grief can have important consequences. And although different individuals and occupational groups can adopt a variety of strategies to handle sorrow, silent grief might lead to doctors’ depression, distraction, stress, lack of productivity, guilt, burnout or even decision to change careers.

The good news is, instead of blaming ourselves, ignoring grief and suffering its drawbacks, with experience, the way doctors cope with grief can change. Humans are intrinsically social creatures that benefit from connecting. So normalising grief support is the natural thing to do. Sharing experiences and emotions with significant others and colleagues who are in the medical field, giving ourselves permission to display emotions on the job, calling or writing to the deceased patient’s next of kin, and taking time to process these away from the workplace are just a few strategies.

With a growing older comorbid population, we need to emphasise to medical students and new doctors that caring for themselves is just as important for caring for their patient. A good start is the integration of open discussions on grief responses and coping education in the medical curriculum. There are informative websites with resources, health care grief support groups for face-to-face encounters, online communities of like-minded individuals to safely and anonymously debrief, free counselling for GPs, and the MyGrief application for confidential support 24/7.

All this support for young and new doctors can make them aware that grieving the death of a patient should not be a solitary journey.

Dr Lou Lewis is a GP at Matraville Medical Centre with over four decades’ experience who has seen and supported his patients through the ageing process and withstood the inevitable death of many of his older patients.

Dr Magnolia Cardona is a trained GP, Associate Professor of Health Systems Research and end-of-life researcher at Bond University, and an advocate for older people. She is the co-author of Dying safely.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.

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