Why Doctors Need to Mourn

Shelly Reese

Disclosures

July 17, 2019

Stoicism can also negatively impact a doctor's ability to treat a patient and interact with the patient's family. Some of the oncologists in the study by Granek and colleagues[1] said their feelings distracted them or caused them to become more or less aggressive in treating other patients. Half said their feelings caused them to distance themselves from dying patients.

In a separate study of 535 Canadian medical oncologists, radiation oncologists, and palliative care physicians, published in the Archives of Internal Medicine, physicians who reported a feeling of failure after a patient death and those who preferred to not show emotions were less likely to attend a patient's funeral, write a note, or call the family after a death.[2]

The problem, says Evangeline Andarsio, MD, national director of The Healer's Art, a curriculum developed by Rachel Naomi Remen, MD, for first- and second-year medical students that explores the human dimension of medicine, is that too many doctors interpret "professionalism" and "compartmentalization" to mean putting their emotions in a little black box on a shelf.

We are human and we witness a lot of suffering and death in our profession, and there must be ways to process it at appropriate times.

"There's an attitude among doctors that you can handle anything. It almost makes you almost think John Wayne was the father of medicine," she says. "But the bottom line is that we are human and we witness a lot of suffering and death in our profession, and there must be ways to process it at appropriate times. Yes, there's a need for compartmentalization, but you have to acknowledge that the grief is there, and you have to work through it. You can put it in a box temporarily, but you have to take it out and work through it."

Physicians who tuck away unresolved grief are more likely to suffer burnout or turn to dysfunctional coping strategies, such as avoidance, denial, anger, drugs, or alcohol that, according to Andarsio, "may temporarily numb pain but won't heal loss."

Alan Wolfelt, PhD, founder and director of the Center for Loss & Life Transition and a faculty member of the University of Colorado Medical School's Department of Family Medicine, says grief is an internal, emotional response to loss, but unless physicians find a way to express those emotions, they risk becoming "physician functionaries," unable to fully engage with their patients and their families.

Walking the Razor's Edge

That's not to say that physicians need to wear their emotions on their sleeves. Wolfelt notes that some physicians may want to express their grief privately by observing a few moments of silence and reflection, journaling, or lighting a candle. According to Andarsio, others may need more psycho-social support, particularly when their grief is complicated by the fear of a lawsuit, hurt over a family's anger, or guilt that they might have failed in some way.

"Grief and loss aren't a one-size-fits-all experience," notes Granek. "Individuals are different in what they want and what types of interventions they think would be helpful. Some want more training to help them deal with their emotions, others want more vacations and sabbaticals to restore themselves, and many simply want validation that grief is inextricably embedded into their work," she says.

Physicians walk "the razor's edge between life and death," adds You, and the healthcare system is only beginning to explore ways to help them keep their balance.

For example, many medical schools have incorporated electives such as The Healer's Art into their curricula, and practicing physicians have access to bereavement training sessions such as those conducted by Wolfelt. Some professional associations, such the American Academy of Pediatrics, which launched its "Resilience in the Face of Grief and Loss Curriculum" in 2016, have introduced programs to help their members.[3] Hospitals and health systems are becoming more proactive as well by offering support services, holding debriefings in certain circumstances, and sponsoring periodic memorial services.

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