The grief that physicians feel over the loss of their patients is something that is often significantly underestimated. With Mount Sinai Hospital physicians treating patients with increasingly complex cancers as well as many other complicated illnesses, patient loss is a reality of the profession.
A recent study published online in Archives of Internal Medicine by The Hospital for Sick Children’s Leeat Granek, suggests that the struggle to process grief can be quite significant for many Ontario physicians. The study demonstrates that oncologists may experience profound emotions surrounding the loss of their patients, and that in some cases this can lead to difficulties in their personal and professional lives. Furthermore, within medical culture, grief can sometimes be considered a sign of weakness, further perpetuating an already isolating emotion.
Dr. Bill Mah, a psychiatrist at Mount Sinai runs a monthly group for palliative care physicians and one of the only programs of it’s kind in Canada. “We provide a space for them to metabolize the feelings that arise when providing care for dying patients,” says Dr. Mah. “The challenge for these clinicians ― and this includes nurses and other members of the health-care team who also may experience profound loss ― is that they need to attach themselves well enough to their patients in order to provide good care, but loosely enough that they can move on afterwards and be okay with it all.”
Striking this balance may be a critical factor in the ability of clinicians to manage these complex emotions. Dr. Peter Ferguson is an orthopaedic surgeon in the Sarcoma Unit at Mount Sinai. While he admits that early on in his career he experienced some of the emotions suggested in Granek’s study, he has since developed strategies which he feels have helped. “When I encounter difficult situations, such as delivering bad news to a patient, I make a point to be completely present in the interaction with them, and I set aside as much time as is needed. I will sit with them and hold their hand as they cry, I will answer all their questions and I will be completely honest and realistic,” explains Dr. Ferguson. “I think knowing that I deal with the pain of the situation head-on, and that I give them everything I’ve got both during those tough conversations and throughout their treatment, helps me process the grief and move forward successfully.”
Dr. Alexandra Easson is a surgical oncologist at Mount Sinai, and sees many patients with very complex cancers. Dealing with the emotional impact of patient loss is something that she makes a point of trying to talk about. “For me, being honest and talking about it – mostly with colleagues who can relate – helps a lot.” Sharing the emotions actually helps to unload some of the weight she might otherwise carry around with her. Dr. Easson also tries to encourage residents to explore their thoughts about grief, and tries to debrief with them after difficult situations. “No one focused on these issues when I was training. It’s so important, and a very real part of the work we do.”
Dr. Easson is also a firm believer in the importance of boundaries in physician-patient relationships. “You need to have them in order to do this job. It doesn’t mean we are cold or that we don’t care…we care a lot,” she explains. “When I lose a patient, they aren’t gone for me. They live in my memory and I think about them.” Perhaps most of all, it’s Dr. Easson’s attitude about the nature of her work that helps her through it. “Being able to share in some of the most profound – albeit very difficult – moments of someone’s life is a rare privilege. I feel very lucky to be with them on their journey.”
While there are many who have developed successful coping methods, Drs. Mah, Ferguson and Easson all agree that more resources are needed. The success of a group like Dr. Mah’s is a shining example of a program that aims to meet the needs of physicians who are seeking additional support.
Having more substantial grief training in medical school would especially help newer physicians develop useful coping strategies from the outset. For more experienced physicians, programs mandated by professional associations for credit, perhaps even ones for which physicians are remunerated, would encourage participation and awareness, and decrease stigma about these important issues. “Resilience can definitely be taught,” explains Dr. Mah. “We can bolster resilience and provide strategies to cope with the anxiety and stress in useful and productive ways.”