A guest column by the American College of Physicians, exclusive to KevinMD.com.
Recently, I’ve been thinking about how physicians express condolences. This weekend, I attended calling hours to visit with the family of a recently deceased patient. As I drove back from the funeral home, I tried to recall when I started to attend my patients’ wakes, funerals, and Shiva observances, and why I began this practice. It wasn’t something that I was taught in medical school or residency. Perhaps things have changed by now, but back then, there was very little formal teaching on how physicians should interact with families after a patient’s death.
I did a quick review of the literature on this topic to learn how frequently physicians contact families after a patient’s death and how they make those contacts. I couldn’t find very much, but a 2015 study in the Journal of Palliative Medicine provided an overview of how providers on staff at the University of Washington Medical Center expressed condolences. Using an online survey, the authors found that 55 percent of those who responded to the survey “often” or “always” expressed condolences to the family after the death of a patient. Outpatient physicians were slightly more likely to do so than their inpatient counterparts. The most common methods were phone calls and condolence notes; 4 to 5 percent of respondents did it in person. Providers in practice for 20 or more years were more likely to express condolences than those with less experience.
While I don’t remember how I got started, I know why I continue to try to attend my patients’ wakes, and if I can’t be there, send a note or make a phone call to the family. The primary reason is that this is part of my taking care of my patients.
That sounds straightforward, but that doesn’t always make it easy. Patients’ final days can be complicated, if not tumultuous — hospitalized patients under the care of physicians they just met, family members disagreeing on treatment plans, or unexpected outcomes can make a patient’s death more uncomfortable than it would otherwise be.
At times, I’ve made phone calls to family members or shown up at calling hours with butterflies in my stomach because I didn’t believe that things went all that well, not knowing how my presence would be received. Those concerns turned out to be unfounded, as I’ve always been made to feel welcome and my taking the time to be there appreciated by the family.
“Appreciation” may be an understatement, as not only do families thank me for coming, but they also thank me for being their loved one’s physician. It’s been gratifying to hear relatives that I met for the first time on the receiving line at a wake tell me how their departed relative talked about how they liked, even “loved,” their doctor. Sometimes, I’ve even felt like a celebrity or a long-lost relative, getting introduced to other family members as “this was Mom’s Doctor.”
When a patient dies, it’s not uncommon to feel bad and wonder if you could have done anything differently. When a grateful family thanks you for all that you did and you realize how much you meant to that patient, those doubts are cast aside, at least for the moment. I think that it is ironic that a situation that at first glance could decrease a physician’s morale can actually make a physician feel better.
Another reason why this outreach is important is that its impact extends beyond the patient’s immediate family, especially for those of us who practice in a community. When we’re expressing condolences on the death of a patient, we’re also supporting other patients who may have been neighbors, former students, or colleagues of the deceased. Your being there means something to them as well.
Lastly, my attending a wake helps me to achieve what many refer to as “closure.” We’re told as trainees that we should maintain a level of detachment from our patients, but when you visit with them a few times every year for, in some cases, over 25 years, experiencing their medical and personal adventures, that person becomes more than a name on your schedule. They share their joys and sorrows with you, and you become a part of their life.
As much as we are trained to “deal with” our patients’ deaths, losing a patient, whether it’s expected and planned, untimely and resisted, or sudden and catastrophic, leaves me with an emptiness that visiting with family members fills. Whether it is reminiscing over something important to the deceased, or sharing a laugh over something he or she said or did, it helps me to move on. And, as I noted above, it makes me feel better about what I do.
This is the time of year when the “wise and weathered” offer advice to the new physicians who are beginning their training. A great example of this is A Letter to New Interns in the July 4 Annals of Internal Medicine. My “pearl” to my new colleagues is to make expressing condolences a routine part of your practice. Whether its writing letters, making phone calls, or expressing it in person, show your patients’ survivors that you care. Show yourself that you care.
Yul Ejnes is an internal medicine physician and a past chair, board of regents, American College of Physicians. His statements do not necessarily reflect official policies of ACP.
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