There’s an interesting piece in the New York Times here about the emotional difficulties doctors experience when working with people who are going to die. People often characterise doctors as cold and uncaring when, in fact, they may simply not be coping:
We found that oncologists struggled to manage their feelings of grief with the detachment they felt was necessary to do their job. More than half of our participants reported feelings of failure, self-doubt, sadness and powerlessness as part of their grief experience, and a third talked about feelings of guilt, loss of sleep and crying.
Our study indicated that grief in the medical context is considered shameful and unprofessional. Even though participants wrestled with feelings of grief, they hid them from others because showing emotion was considered a sign of weakness. In fact, many remarked that our interview was the first time they had been asked these questions or spoken about these emotions at all.
Even more distressing, half our participants reported that their discomfort with their grief over patient loss could affect their treatment decisions with subsequent patients — leading them, for instance, to provide more aggressive chemotherapy, to put a patient in a clinical trial, or to recommend further surgery when palliative care might be a better option.
Unease with losing patients also affected the doctors’ ability to communicate about end-of-life issues with patients and their families. Half of our participants said they distanced themselves and withdrew from patients as the patients got closer to dying. This meant fewer visits in the hospital, fewer bedside visits and less overall effort directed toward the dying patient.
Oncologists are not trained to deal with their own grief, and they need to be. In addition to providing such training, we need to normalize death and grief as a natural part of life, especially in medical settings.
To improve the quality of end-of-life care for patients and their families, we also need to improve the quality of life of their physicians, by making space for them to grieve like everyone else.
Last year my daughter – who had been experiencing lung issues for several years was diagnosed with a tumour. An Op was deemed necessary and some of the lung was removed. Thankfully, after some very anxious time, we were given the all-clear. She is slowly returning to health.
It struck me as we did the rounds of Oncology specialists and health professionals that all of them were genuinely delighted when they realised that things would turn out OK. I realised this is a fairly depressingly unusual outcome for them.
People make assumptions about how professionals deal with death and dying. My palliative care sister certainly feels sadness as part of her work life.
I suppose some of us cope better than others. The professionals I would try and avoid are those who never really become emotionally involved on any level with their patients or clients.
David – I’m pleased to hear that your daughter is recovering. I completely agree with you about our assumptions. My sister works in a neonatal ICU and she and her colleagues get very close to the babies and their families. She tells me she gets extremely emotional at each baby’s funeral she attends.
Glad to hear your daughter is doing well – that must have been an incredibly worrying time for you all.
As you rightly say some cope better than others – but maybe some are better at masking their pain for the sake of everyone else. As we are fond of saying – you never know what burdens someone else is carrying, you really don’t, and that includes doctors, nurses, FDs, celebrants, neighbours, shop assistants, taxi drivers…. well the list is endless. I’m sure this article is correct in its comments about grief training for medics too. Watching any of the ‘hospital docudramas’ shows that they are also torn to pieces when they ‘fail’ because that’s what it feels like when a patient dies, so it’s good to hear your side of the story when they succeed, thank you. Our expectations are incredibly high as we walk through those hospital doors… about life? death? success? failure? Hmmm lots to think about.
Thank you both. Yes, it was an incredibly difficult time for all of us. I know that the experience will make me better at my job.
Life is full of surprises, not all of them nice. Evelyn I agree, most people never give a thought to what the people they come in to daily contact with are coping with. All of us have our own story.
Not long ago, when making arrangements for a cremation form, I rang the doctor concerned and said, “my condolences on the loss of your patient.” Seemed natural enough to me, but the poor man was completely nonplussed, and told me it was a first for him.
How can you get close enough to others to be effective if you deny your own feelings?