Like smoke, this grief was intangible and invisible. Nonetheless, it was pervasive, sticking to the physicians’ clothes when they went home after work and slipping under the doors between patient rooms. Of greatest significance to our health care system is that some of the oncologists’ reactions to grief reported in our study (eg, altered treatment decisions, mental distraction, emotional and physical withdrawal from patients) suggest that the failure of oncologists to deal appropriately with grief from patient loss may negatively affect not only oncologists personally but also patients and their families. One way to begin to ameliorate these negative effects would be to provide education to oncologists on how to manage difficult emotions such as grief starting at the residency stage and as continuing education throughout their careers, with the recognition that grief is a sensitive topic that can produce shame and embarrassment for the mourner.
[Some]Supporting Quotations Resulting From Data Analysis
“Sometimes I’ll take a chart and I’ll look at the imaging, and everything’s worse and the numbers are worse, and I have to drag myself into the patient’s room and figure out what can I offer them that’s hopeful and positive. It’s tough.”
“Let’s face it, people who go into medicine have full-blown fantasies, I mean, I do. You think you’re going to go in there to cure people . . . and it doesn’t happen. It doesn’t matter what you do really. . . . Sometimes I make an impact on what happens but sometimes I just get steamrolled.”
“It is part of the grief of the patient because, you know . . . someone has died and you always think, if you had done something differently, would they still be here?”
“If I felt that there was something else I could have done or something that I did in error then there’s definitely a different component of guilt to kind of, you know, feeling even possibly responsible for the events that subsequently occurred.”
“There is a personal sense of failure any time a patient doesn’t get a desirable outcome.
So, the grief is that this is a person who you’re not able to help.”
“There’s always sadness with every loss.”
“It keeps me awake at night.”
“Sometimes I cry. I cry on the way home in the car.”
“I think you just get exposed to so much death that you just become somewhat accustomed to it. . . . It’s part of our job. I mean death is normal, everybody dies, it’s just that we experience a larger amount of it.”
“I go through weeks where it’s very difficult to come into work. I come in and I don’t really want to be here at all. It’s an effort to drag myself down to clinic . . . because I know that I’m going to see patients who are going to do badly.”
“It is a very bad thing to become emotionally attached to your patients because you’re going to suffer.”
“It’s something bad, but I have to keep my personal feelings and personal life separate from my work feelings and work life. I have to keep reminding myself to have a little bit of dissociation like that, so I can sleep every night and not carry things home.”
“In your mind you know that death is closer and closer. But you never fully prepare yourself; in order to cope you always have to have a little bit of denial.”
Author Affiliations: Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada (Dr Granek); Department of Medical Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada (Dr Tozer); Palliative Care Consult Team, Sunnybrook Health Sciences Centre, Toronto (Dr Mazzotta); Department of Family and Community Medicine, University of Toronto, Toronto (Dr Mazzotta); McGill Clinical and Health Informatics, Montreal, Quebec, Canada (Ms Ramjaun); and Department of Medical Oncology & Hematology, Princess Margaret Hospital, Toronto (Dr Krzyzanowska).
Published Online: May 21, 2012. doi:10.1001/archinternmed.2012.1426 via Full Text Reports. PDF: Nature and Impact of Grief Over Patient Loss on Oncologists’ Personal and Professional Lives
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