WHEN A PATIENT DIES, WHAT’S THE DOCTOR’S ROLE?
WHEN A PATIENT DIES, WHAT’S THE DOCTOR’S ROLE?
A couple of years ago I wrote a blog about the death of a patient, and the doctor’s response to it. The physician has a responsibility to acknowledge the death, report the occurrence to the family, and provide support and comfort to those grieving the loss. Doctors take care of sick people and sick people sometimes die, so although it’s not a daily or weekly occurrence, deaths do happen. A doctor needs to have a professional attitude and demeanor and be able to deal properly with family members who may not understand why their loved one has died.
Unless you’re a pathologist or a physician who doesn’t do direct patient care, you’re going to deal with patients who die. Imagine how difficult it must be for ER physicians who deal with major trauma, heart attacks, gun shot wounds, and the terminally ill every day. They don’t know the patients they’re treating, the patient’s distraught family doesn’t know the doctor, and the catastrophic scale of many of their encounters can be overwhelming. Giving bad news to family members can be a several-times-a-day occurrence, and not always result in harmonious behavior.
While ER doctors deal with sudden unexpected catastrophes, every day the oncologist sees patients he knows will probably die. Very often, he has the difficult responsibility of telling a patient he/she has cancer and that available treatment is recommended. But he also knows there’s no guarantee it will result in a cure. It’s the oncologist’s responsibility to be optimistic, reassuring, and instill realistic hope and optimism every time he sees the patient. Being upbeat for every patient, every day, takes a person with a positive, confident, comforting personality who must not become discouraged. Patients need the truth of their cancer status, but they also need hope to keep on going. It’s a difficult situation for the oncologist because he knows a high percentage of his patients will eventually succumb to their disease.
Most patients die in an acute care hospital. The remainder die at home or in a nursing home. Hospital deaths most often occur in patients with terminal illnesses or as a result of post-operative complications. Deaths at home also are most often from long term illnesses, but may occur suddenly and unexpectedly. Any death is difficult for families, but relatives of the terminally ill usually have had weeks or months to begin the grieving process. A sudden death, however, is very emotionally traumatic for loved ones, and the seven stages of grief take awhile to work through.
The family doctor is the physician who knows the patient the best and for the longest time. He/she must involve himself in the situation in the manner he knows will provide the most comfort to the family.
When his/her patient dies, I think it’s very important for the physician to do the following things:
- Personally express your condolences either in person or over the phone.
- Talk about the deceased in a clinical sense, but show compassion and understanding
- Provide distraught family members the chance to vent and recognize their grief
- Prescribe limited, small doses of medications appropriate to the person’s need
- Attend the deceased’s funeral calling, or funeral, and speak to as many family members as possible
If the situation doesn’t permit the above options, I think a handwritten sympathy note is a suitable alternative. Every family and every individual has his/her way of grieving the death of a loved one, and most grieving folks appreciate hearing from people and knowing they care. Showing kindness and concern rarely has negative consequences so at the time of a patient’s death it’s very important to express those feelings. If the death of a patient doesn’t touch the doctor’s emotions to some degree, he/she needs a career change.
It’s never easy to tell people their mom/mother died. You don’t know how they will react. Reactions vary from disbelief, to fainting, to solemn acceptance, and even outright anger. It’s important to give the family time to cry, to ask questions, to gain an understanding, and to vent if they need to. Just the doctor’s presence is often enough to calm emotions.
The family doctor is an extension of the family unit. He/she is often considered a close friend. Being absent during such an important, emotion-filled, difficult time in a family’s life is a big mistake. Only through experience does the doctor acquire a comfort level adequate to “say and do the right things.” Just his/her presence is often the reassuring gesture a grieving family needs. In today’s medical world that doesn’t happen very often, but it should.
