Physicians devote their careers to improving and preserving their patients’ health and longevity. But along with the success and fulfillment physicians often derive from practicing medicine, grief and loss permeate the profession as well. In the traditional culture of medicine, the latter emotions are not just undiscussed, but also poorly understood.
“Medicine is one of those things that you’re (culturally) supposed to do every day with a badge of honor, and just keep doing it harder,” says Mohana Karlekar, MD, FACP, FAAHPM, medical director of palliative care and assistant professor in the department of general internal medicine and public health at Vanderbilt University Medical Center. But given the risks of professional burnout, compassion fatigue and chronic stress, physicians need to take a more realistic approach to coping with loss, she says.
“As a palliative care physician, (I see) a lot of people die who are very sick, and my primary care practice has quite a few palliative care patients,” she says, noting that the grief process is somewhat different with predictable deaths and those that are sudden. Likewise, some physician-patient relationships are long-term, while some are episodic.
However, they all have an impact that’s crucial for physicians to recognize and acknowledge, she says.
Just a week before being interviewed by Physicians Practice, Karlekar cared for two young adults who died unexpectedly — one in a house fire and the other from a new onset of heart failure. “I didn’t know them before this week, but there’s grief in that,” she says. For Karlekar, it helps to talk about grief, let others know about it and to practice self-care through exercise.
However, it’s rarely possible for physicians to take those steps immediately after a loss. “Sometimes, you’ve got to get to the next patient or the next task, and you don’t have the time or space to process. Try to find some time in your life to go back and deal with it,” she says. “Because if you ignore it, it tends to come back at you in different forms.”
Create a safe space
Physician practice leadership plays a substantial role in creating an environment in which all members feel safe acknowledging their emotions, says Christine Moutier, MD, chief medical officer of the American Foundation for Suicide Prevention. Rocked by the suicide of a fourth-year medical student during her psychiatry residency at the University of California, San Diego, Moutier has spent her career training healthcare leaders, physicians and patient groups to improve the healthcare system’s approach to mental health, fight stigma and optimize care for those suffering from mental health conditions.
“It was such a shocking and jarring experience of confusion and grief,” she says of her classmate’s death. “(As physicians, we) really hold ourselves to an irrational sense of responsibility for all things. You think you should have been able to see it coming,” she says, adding that loss survivors in general tend to criticize themselves for missing a suicide victim’s distress.
In terms of preventing suicide as well as helping healthcare teams recover from grief and loss, it’s the responsibility of every school, training program and workplace to create a culture that is safe and respectful, Moutier says. “People must get ongoing signals that are not just top-down, but that are actually being lived out. (It must be clear) that this is a place where every person is valued and respected and where you can get your needs met in a healthy, proactive manner.”