Often I have thought about doctors and their grief. Too often they get the bad rap for being desensitized. Is this the case though? I remember the first time I thought about what a doctor must go through was in 1998 when I saw the very first scene from the movie City of Angels with Meg Ryan and Nicholas Cage. She had failed with surgery and felt so responsible. It’s been years since I lost my grandparents to cancer, but I still wonder if the feeling of grief hit the doctors when their patient passed away.

Do doctors grieve when their patients die? Yes, according to a report in the journal Death Studies a group of internal medicine colleagues found a report that said not only do doctors experience grief, but if they show their emotions in the professional arena there will be professional consequences for themselves as to the quality of care they give to patients
The study took place from 2010 to 2011 in three Canadian hospitals. Twenty oncologists who varied in age, sex, and ethnicity and had a broad range of experience in the field were interviewed. They found that oncologists struggled managing emotions and experienced feelings of failure, self-doubt, sadness and powerlessness in spite of the necessary detachment to do their job. The study also revealed that even though they struggled with feelings of grief, they hid them from others because showing emotion was considered a sign of weakness. Many said that it was the first time they had been asked about these emotions at all.

Doctors get a bad rap from many loved ones because of their grief. The grief that we don’t see from doctors is what we complain about and exactly what we don’t want our doctors to experience: inattentiveness, impatience, irritability, emotional exhaustion and burnout.
Half of the participants from this study reported that their discomfort with their grief over patient loss could affect their treatment decisions— leading them, 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. Some oncologists are unable to stop treatment when it is clearly futile, and “they should” discontinue treatment. They keep trying.

Many physicians will distance themselves from their patients, scheduling fewer appointments because they are uneasy about losing patients. Some don’t have the ability to communicate about end-of-life issues with the patients and their families. The visits are fewer with them by their bedside in the hospital less effort is directed toward the dying patient.

Most physicians want what is best for their patients even if the outcome is an inevitable dealing with the end of life. It is never comfortable for physicians who are expected to deal with end-of-life, so they put up some emotional boundaries: can you imagine if they didn’t?
There would be doctors walking around openly expressing their grief, and this would be unacceptable professionally.

Unexpressed grief has proven to have an adverse impact on the personal lives of oncologists. Oncologists are for the most part not trained to deal with “their grief, just to suppress it. It is not easy to normalize death and sorrow in a medical setting. Talking about this to a patient or family will always cause distress because they will refrain from showing emotional grief. Avoiding the topic simply because they are all out of options to improve the quality of their life or extend the patient’s life is very distressing.

To improve the quality of end-of-life care for patients and their families is important as well as helping them with their grief but we also need to recognize that the quality of life of their physicians is important too because they are the ones trusted to care for their loved ones. Often the grief-stricken family will blame the doctor, and the medical community does not provide opportunity or space for them to grieve like everyone else.

I understand better now what doctors must do to get through their grief. I respect them and I recommend people share this information so we can get a better understandng of what they must do to keep it together emotionally so they can do the job as professionally as we need them to.

Sunday Review New York Times
When Doctors Grieve
Gray Matter