Thursday, May 28, 2009

Physician bereavement practices

Archives of Internal Medicine also has a fascinating survey of physician bereavment/condolence practices. The study involved a national survey of Canadian medical & radiation oncologists and palliative care physicians (mailed to members of the 3 main professional societies). There was a 71% response rate, which is good for these type of studies.

Basically, bereavement practices were generally spotty: about a third of respondents 'usually' did something (card, call, attend a service - phone call being the most common of the 3), about a third 'sometimes' did one of those, and the other third rarely did. Palliative docs were more likely than oncologists to do condolence actions. In fact, being a palliative doc was a strong predictor of doing some bereavement practice; however working in a setting without a palliative care program also was a predictor - suggesting that these activities are being delegated/transferred to palliative care clinicians.

They also asked some revealing questions about physicians' attitudes towards patients' deaths, the role of family members, etc. There was one (literally) palliative doc who 'strongly disagreed' with the statements they 'like to meet patient's family members' and they 'like to treat patients as part of a family unit.' A very few oncologists disagreed with these statements too, but who is this palliative doc? Didn't they read the WHO definition of palliative care? Actually in the discussion they mention it was a palliative doc from Nova Scotia, so watch out if you're heading Halifax way***.

Anyway - there were some striking differences in some of the questions between palliative docs and others. One was whether the docs felt a sense of failure after a patient's death: literally none of the palliative docs did (and 92% disagreed with that statement). Only ~50% of the oncologists disagreed with that statement. In some ways I was surprised it was that high, and it reminded me of a friendly discussion I have with an oncologist colleague of mine about who has the tougher job (emotionally speaking). He thinks I do because I spend most of my time working with dying/soon-to-be-dying patients. I think he does because even when I've known a patient for a long time, even years, I rarely am in a position in which that patient expected/hoped of me to 'cure them' or help them live as long as possible. I'm always happy to oblige that when I can, but most of my patients understand/accept I do something else. This is not true of oncologists who have to go through the transition of being for (many) patients in the role of being an 'agent' of curative treatment or at least life-maximizing treatment to one in which they can longer be that agent. Even if they've given impeccable, excellent medical care (which is all we can and should ask of ourselves as physicians) that transition is inevitably difficult for many oncologists. Feels like failure, feels like you've let this person down. Oncology training ideally should be structured to explicitly address and 'prevent' this but I don't think it often does. Anyway: I think that's much tougher than what I do (most days).

I'm curious as to what readers' condolence practices are, if any?

(Image by Ian Britton/

***This is a joke (about Nova Scotia, there was in fact one palliative doc who apparently hates patients' families) - sorry to PM, RH, DH, LA - I know you're reading this.

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