How physicians cope with patient death

Janice Knebl, DO, once saw 10 patients die in a single 24-hour shift. As a geriatrician and palliative care specialist, she notes that seeing the end of patients’ lives is a significant part of her job, but the experience is still jarring every time.

After each patient death, Dr. Knebl processes her grief by saying a prayer and pausing for a few moments of quiet time before moving on to the next patient.

Physicians often develop close relationships with their patients, and may eventually lose one. Grief-related job stress may become job-related burnout, which can affect up to 50 percent of physicians treating terminally ill patients. It’s important for physicians affected by the loss of a patient to find a healthy way to cope.

“Patient death is what wears on you the most,” says Lisa Kopp, DO, a pediatric and adolescent oncologist.

Below, several DOs share the coping mechanisms that they’ve found to be most helpful in processing patient death and moving forward afterwards.

1. Express emotions

It’s healthy to let yourself feel loss.

“Let emotions happen, it makes you human and empathetic. It takes time to get over a death, and it is okay to remember those that have died,” says trauma and general surgeon Kelly Dinnan, DO.

Dr. Knebl has very close relationships with her patients and their families. She will sit and sometimes even cry with them. She has also attended patients’ funerals.

“I don’t have a problem with shedding some tears,” says Dr. Knebl, the Dallas Southwest Osteopathic Physicians endowed chair in geriatrics at the University of North Texas Health Science Center.

Showing emotion in front of the patient’s family is okay, but having a breakdown can make the patient’s loved ones feel that they need to be comforting you.

“It is our role to comfort them,” says Dr. Kopp, who works for Banner University Medical Center/Diamond Children’s Medical Center at the University of Arizona Cancer Center. “However, if physicians cry, they should not feel ashamed. It is part of being human.”

2. Take time to reflect

Every physician will process a patient death in their own personal way.

Dr. Kopp prefers to take a moment to reflect on her time spent caring for the patient, remembering positive interactions between herself and the patient.

Dr. Knebl relies on her faith. She compares her role as a geriatrician and palliative care physician witnessing the end of life to that of an ob-gyn delivering the miracle of life. In her eyes, both events are natural milestones.

“Each of us have our own internal coping mechanisms, “ Dr. Knebl says. “Find what’s going to work for you to handle that loss and to continue to be effective for your patients and families.”

Dr. Dinnan hugs her dog and husband and also practices yoga. She encourages residents and students to talk to their loved ones and tell them you love them.  She also recommends that everyone read Atul Gawande’s “Being Mortal.”

3. Embrace “We”

To help combat the negative thoughts after patients die, when Dr. Kopp speaks to family, she frames everything using “we.”

Phrases like, “I can’t cure your child,” or “I failed you,” place too much of a burden on physicians, she says. She also reminds herself that there are limits of what she can do to help patients.

“It’s not just me who can’t cure the child, it’s modern medicine,” Dr. Kopp says.

Dr. Dinnan, the medical director of the surgical ICU at Beaumont Health in Farmington Hills, Michigan, encourages physicians who feel devastated after a patient death to come together and deal with the loss as a group.

“Great physicians are self-aware and willing to speak up about uncomfortable topics,” she says.

4. Dispel the feeling of failure

While there’s nothing you can change about a patient having cancer or another life-ending illness, it’s natural to feel a sense of failure after a patient dies, Dr. Kopp says.

However, it’s also important to combat this feeling. Dr. Kopp does so by conducting research, supporting patients and participating in community service projects. She uses every patient experience as a way to reflect on how she can move the field of pediatric oncology forward—a practice she has credited with helping her avoid burnout.

Dr. Dinnan combats feelings of failure by remembering successful outcomes she’s had with other patients. She also relies on her senior partner and father for encouragement.

5. Define your role

Society thinks of physicians as healers, and it’s easy to fall into the trap of viewing your role–and worth–solely in terms of being able to cure patients, says Dr. Knebl.

Dr. Knebl prefers to view the role of the physician as always providing comfort, and healing when they can.

“If you look at your role to cure always, you will always feel like you’ve never done enough, “ she says.

For patients who can’t be cured, Dr. Knebl recommends physicians strive to give them the best passing possible by helping them get their affairs in order and making sure they experience minimal pain.

For further reading

How to break bad news to patients: Experts offer best practices

How to deliver bad news to ob-gyn patients: Tips for DOs 

Fearing license issues, depressed doctors don’t get help