Karlekar agrees, adding that there is no one-size-fits-all framework to promote emotional health. “The assumption can’t be that at 2 o’clock on Friday, let’s all talk about our feelings,” she says. Individuals have varied comfort levels and needs, which she says should be honored.
“Right now, one of my nurse practitioners is seeing a lot of 20-year-olds on the trauma unit,” Karlekar explains. To help lessen the emotional toll, Karlekar has made time to converse with her via text. “Some of it is just, ‘Hey, how are you doing? Do something nice this weekend.’”
Another technique practices can adopt is to create a quiet room in which clinicians and staff can take a few moments to reflect, meditate, complete paperwork or simply take a breather.
In some cases, Karlekar invites members of her healthcare team to gather in the aftermath of loss. “We have had some intentional debriefs when things have been really tough or when someone who touched everyone has died,” she says. “I had a patient with cystic fibrosis who died a week before his 30th birthday. Our floor team had been taking care of him for about five years. We had counselors come in and meet with the nurses.”
Normalize grief support
Leeat Granek, PhD, associate professor at York University’s School of Health Policy and Management in Toronto became interested in learning more about physicians’ grief after losing her mother to breast cancer in 2005. Throughout the nearly 20 years her mother lived with the disease, Granek says she developed very intense relationships with the healthcare team. “I started to wonder after she died what happens to all of these relationships that suddenly get severed.”
As a result of interviewing many oncologists who had lost patients in their care, Granek has gathered empirical data about the types of support they would like to help them cope with grief and loss in the workplace. Top requests included training during residency and fellowship about how to cope with patient death, having their emotions validated and vacation time to recharge.
Whatever the options, they must be non-stigmatized, Granek says. “Oncologists said they didn’t talk about this because they thought emotion was a stigma and that they would be considered weak or vulnerable if they showed emotion.”
One of her recommendations, therefore, is to have oncologists opt out of interventions rather than opt in. Examples of wellness offerings may include gym memberships, mindfulness classes or one-on-one counseling. “It reduces the stigma because it’s the expectation and the norm that everybody participates in one of these things,” Granek says.
Let go of guilt
While Granek’s work is specific to oncology, it provides a previously unseen glimpse into physicians’ thoughts and feelings about patients’ setbacks, suffering and death. In one of her studies, published in JAMA Internal Medicine in 2012, Granek and colleagues discovered that when oncologists lose patients, their sense of loss is two-fold. Not only do they experience “normal” symptoms of grief such as sadness, fatigue and missing the person who died, but they also struggle with a profound sense of personal responsibility as well.
“The oncologists were talking about things like a sense of powerlessness, failure and guilt — and those things are particular to this context where the physician really feels responsible for the patient’s life,” Granek says.
In comparison, she explains, “When my mother died, I didn’t really feel a sense of failure or powerlessness because I had no responsibility or control over whether she died.” Of course, physicians don’t bear this burden either, she says. “They do their best and hope the treatment is going to help the patient, but whether it does or not is ultimately not in their control.”
Nonetheless, physicians’ feelings of failure don’t just compound their grief. They also influence future patient care, such as by avoiding end-of-life conversations, delaying palliative care or choosing more aggressive chemotherapy, “even though, on some level, they knew that it was unlikely to be helpful,” Granek says.