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Coping with grief: How do health care workers process the death of a patient?

March 20, 2024

Tasia Isbell, a pediatric resident physician at Boston Children’s Hospital and Boston Medical Center, is no stranger to the experience of losing a patient. In a KevinMD piece, Isbell described the traumatic feeling of losing a four-year old patient in the ER, only to then walk into her next patient’s room and apologize for the wait. A few short months later, she opened her EHR inbox to see the short, impersonal message from a colleague about another loss: “FYI, your patient died.” (Isbell, 2023)

Medicine, she writes, has the tendency to focus on “the next” and not allow for the space to process loss. Indeed, a 2019 meta analysis found that providers commonly experience moderate and sometimes long-term grief after patients’ deaths. Researchers concluded that, when left unexamined, loss-related emotions can leave HCWs vulnerable to burnout, disengagement, and poor clinical decision-making. (Isbell, 2023; Morrison, 2023)

The importance of coping mechanisms

In a recent study, researchers conducted semi structured interviews of 28 mid-level and senior surgical residents from 14 academic, community, and hybrid training programs across the U.S. to understand their coping strategies. Residents described relying on both internal and external strategies. Internal strategies included a sense of inevitability, compartmentalization of emotions or experiences, thoughts of forgiveness, and beliefs surrounding resilience. External strategies included commitment to change, personal practices such as exercise or psychotherapy, and support from colleagues and mentors. (Bamdad, 2023)

In a study that looked at pediatricians’ grief and coping responses, trainees described avoidance, numbing, and rumination as responses, while attending physicians coped by using positive reframing skills. The importance of experienced physician’s role modeling vulnerability and teaching emotion-focused coping techniques rather than focusing on “getting it right” were highlighted as trainee coping gaps. (Wolfe, 2022)

Creating space for grief and support

Wynne Morrison, MD, MBE, a pediatric critical care physician and director of the Justin Michael Ingerman Center for Palliative Care at the Children’s Hospital of Philadelphia (CHOP), wrote about how she and her colleagues have created deliberate opportunities to support one another through patient deaths. For example, after a loss in the ICU, the team will participate in one last bedside round for the deceased patient, just as they would for any ICU patient. The providers use that time to talk about the child who died. An experienced provider facilitates the session, and attendings may share clinical insights into their decision-making process. They also spend time sharing memories of the patient and acknowledge and normalize the many emotions the team members’ experience. Nursing leaders at CHOP hold virtual debriefings for HCWs who aren’t working the day after a patient’s death, and they inform all ICU staff of any deaths to avoid anyone suddenly discovering the news when they arrive at work, like Isbell did. Morrison’s ICU colleagues at the Hospital of the University of Pennsylvania in Philadelphia conduct longer monthly Grief Rounds to talk about patients who died over those weeks and to share suggestions for coping with loss. (Morrison, 2023)

For her part, Isbell called on institutions to create more opportunities like those at CHOP. She also urges HCWs to take the time to grieve and recognize that you are more than “just a doctor.” “Patients are yours to grieve – fully, wholeheartedly, and without guilt or fear. Your patients will stay with you. I honor my lost patients by giving them space in my mind and heart. Only then do I move on to the next.” (Isbell, 2023)

Sources:

Bamdad MC, et al. (2023, August 1). Ann Surg. What We Talk About When We Talk About Coping: A Qualitative Study of Surgery Resident's Coping After Complications and Deaths. https://pubmed.ncbi.nlm.nih.gov/36994739/

Isbell, T. (2023, April 3). KevinMD. Physicians cry too: 6 tips for coping with death and grief as a health care worker. https://www.kevinmd.com/2023/04/physicians-cry-too-6-tips-for-coping-with-death-and-grief-as-a-health-care-worker.html

Morrison, W. (2023, November 15). American Academy of Medical Colleges. Coming together to grieve when a patient dies. https://www.aamc.org/news/coming-together-grieve-when-patient-dies

Wolfe AHJ, et al. (2022, October). J Palliat Med. Vulnerability of Inexperience: A Qualitative Exploration of Physician Grief and Coping after Impactful Pediatric Patient Deaths. https://pubmed.ncbi.nlm.nih.gov/35333602/