Since the first documented COVID death in the U.S. in February 2020, over 726,000 Americans have died. The number of deaths eclipses the death toll of any other American tragedy, whether war or the Spanish influenza epidemic of 1918, and health care providers have been involved with the care of many people who have died. However, grief among physicians over the death of a patient is not something that we routinely address or even acknowledge.
Most people either understand firsthand what it means to lose a family member or close friend or can imagine that aspect of the human experience, and are sympathetic to the grief and sadness that follow. We understand what it is to lose an acquaintance – someone we know, perhaps peripherally or incidentally, but are not deeply connected to. But a physician’s experience of the death of a patient is much less well understood, partly because the relationship between physician and patient is unique – and partly because we tend not to consider the humanity of physicians in their roles as doctors. A patient isn’t a close friend or family member (hopefully), but we often know intimate things about them and their bodies that even the closest people in their lives do not. We are invested in their health and well-being in ways that mere acquaintances are not. And in the setting of COVID hospital care, doctors may know next to nothing about who their patient is as a person, but will have invested tremendous time, energy, thought, compassion, and worry on that person’s behalf.
Physician grief in response to patient death is poorly studied and poorly understood. A 2014 literature review found only twelve articles that addressed services available to grieving health care providers, and explorations of the scope and universality of physician grief have been scarce. I believe that is largely due to physician grief over patient death being disenfranchised. Disenfranchised grief was first described by Ken Doka as grief that follows a loss that isn’t “openly acknowledged… or publicly supported” and the person, therefore, feels they don’t have the right to grieve or get support. Physicians aren’t supposed to grieve following a patient death because of professionalism. It’s just a part of our jobs, after all. Our medical education specifically trains us to suppress emotional reactions to our work and to power through stressful and traumatic situations. Unfortunately, it doesn’t teach us how to address the emotional reactions afterwards.
Deborah Lathrop argued pre-pandemic that we had a physician workforce already mired in disenfranchised grief from a multitude of losses. I agree. The pandemic has drastically exacerbated the problem, and physicians are suffering. When not addressed and validated, grief contributes to depression, burnout, and anxiety, and adds to the trauma some doctors are experiencing. More physicians than ever are burned out, and an astonishing 37 percent reported they would like to retire in the next year when surveyed in 2020.
We need to begin to address physician grief by validating it and acknowledging that grief following a patient death can happen and is normal. We can support doctors who grieve the loss of a patient, even one they didn’t know personally. We can offer empathy to each other and give struggling doctors the space to process, vent, and regroup emotionally. Doctors who need extra support should seek counseling with a provider familiar with the challenges of medicine and the impact of disenfranchised grief. We need to remember that physicians are human, and grief is as much a part of the human experience as love. There are ways to support physicians both emotionally and professionally. We just have to make the effort.
Vickie Mulkerin is a family physician and owner, White Coat Counseling, LLC.
Image credit: Shutterstock.com
