The condolence letter: A dying tradition among doctors

When a patient dies in the hospital, we go through a checklist that has become eerily mundane. Examine the patient to confirm the death. Notify the family, the senior doctor, the local organ bank, the admitting office, and (in some cases) the medical examiner. Fill out the report of death. Write a death note. Brace yourself against the emotional weight of the event and get on with your work. Nowhere in that process is a responsibility that should predate our medical training: the condolence letter.

I’d never written one for a patient until last week in the intensive care unit when our team’s attending doctor brought up the idea. Instead of a fountain-penned, monogrammed note, ours was typed on hospital letterhead and signed with ballpoint pens. But it was a tribute all the same to what has become a dying tradition among doctors.

It’s a shame that the letter of condolence has gone the way of penicillin and the black leather medical bag. Part of the trouble, at least in the hospital, is that we may not know patients as well or for as long as we used to: hospital stays are now measured in days instead of weeks and residents work fewer, often odd, hours to comply with duty hour requirements. Working in teams, we often shift which doctor has primary responsibility for a given patient so niceties like letter-writing are more likely to get lost in the shuffle.

Beyond the logistical challenges, writing a condolence letter may feel like admitting fault or worse, defeat. The act makes us vulnerable to the heartbreak in our work so we let it slide and rest on the convenient but erroneous assumption that our patients’ families don’t care.

The science of writing a condolence letter is unlikely to be found in a medical textbook. But there is a (not-surprisingly small) body of literature on the topic that offers some guidance, suggesting that we include personal memories of the patient when possible and avoid superficialities and clichés. Regardless of its style, writing an honest letter may help a patient’s family find peace. It is also a chance for us to pause, acknowledge our limits as physicians, and gain closure. I’m adding it to my checklist.

Ishani Ganguli is a journalist and an internal medicine-primary care resident who blogs at The Boston Globe’s Short White Coat, where this article originally appeared. 

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  • http://womanfoodshinyobjects.wordpress.com/ Brian Stephens MD

    I still hand write a short note of condolence to all my patient’s families when they pass. Takes all of 60sec and I feel it is a small tribute to a person that honored me with enough trust to care for them.

    sad to hear it is “dying.”
    I think families get a lot of comfort out of it.

  • http://www.facebook.com/thatsananna Melissa Hausman Oltman

    This is a wonderful reminder – Thankyou

  • ninguem

    Just a plain old sympathy card. Actually, I like to go to the stationery stores and get some really nice handmade cards. Very often, I get nice responses from the families, they seem quite appreciative.

  • http://twitter.com/FerkhamPasha Ferkham pasha

    Must be the hard part of being a doctor

  • http://www.twitter.com/alicearobertson Alice Robertson

    I chose our vet based on the extremely thoughtful handwritten card he wrote and his whole staff signed. They even got our dog’s name right. It’s a nice practice. My daughter still has the personal emails from her ENT that were sent during a time she was dealing with cancer (he moved, but her admiration for him has remained….just incase someone is googling Dr. Philip Daniel Knott….kudos to you:).

  • Caitlin Peebles

    Our vet sent a lovely condolence letter after one of our dogs, whom she had treated for 12 years, passed away.

    No-one involved in my Mother’s medical care, some of whom had treated her for more than 10 years, sent any kind of acknowledgement let alone condolence after she passed away.

    What a damned shame.

  • petromccrum

    After my husbands death I did NOT receive one condolence letter/card/call from any of his doctors. Some of these doctors my husband saw almost everyday for seven months. A year later I am still upset over this. A preprinted card with a signature by anyone in his office would have been better than nothing at all.

  • David Lee Scher

    I used to write condolence letters and even attended a few funerals of some patients. It represented the human connection.

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