Mr D was a patient of mine for many years. His wife and him were the nicest and most compliant patients a doctor can  have. He was suffering from Cirrhosis of Liver due to Hepatitis C for many years. His condition was deteriorating fast over last 6 months. Frequent hospitalizations had become a norm for him. Hospital became his home. He was adamant about not getting a transplant of Liver, but with the worsening of his condition, he agreed to be on the transplant list. I was hopeful that he may do well with it once he gets it. But nature had some other plans. He passed away few weeks later while still waiting to get a liver. The news of his death did not come as a big surprise, but it was definitely hurting. Life has to come to an end one way or the other. Death is the only truth of life. But the grief of a loss of someone close leads to a new thought process. I see pain, misery and death everyday of my life. It does not stop me from doing what I do, but does lead to emotional challenges to be faced.

Do doctors grieve when their patients die? In the medical profession, such grief is seldom discussed – except, perhaps, as an example of the sort of emotion that a skilled doctor avoids feeling. But in a paper published on Tuesday in Archives of Internal Medicine, it was  found that, not only do doctors experience grief, but the professional taboo on the emotion also has negative consequences for the doctors themselves, as well as for the quality of care they provide.

Physicians possess powerful skills for saving lives. Even though deaths are an inevitable part of most physicians’ jobs, they are never taught in medical school how to deal with grief. Moreover, the culture of medicine generally encourages physician stoicism, some of which is necessary. But physicians’ emotional walls, if too high, may not only harm their personal well-being but also affect the way they interact with and treat patients, according to a study published in the Archives of Internal Medicine.

Study took place from 2010 to 2011 in three Canadian hospitals.  20 oncologists who varied in age, sex and ethnicity and had a wide range of experience in the field – from a year and a half in practice in the case of oncology fellows to more than 30 years in the case of senior oncologists were interviewed. Using a qualitative empirical method known as grounded theory, analysis of  the data was done by systematically coding each interview transcript line by line for themes and then comparing the findings from each interview across all interviews to see which themes stood out most robustly.

After systematically coding the results, the researchers made the following observations:

• More than half of the participants reported feelings of failure, self-doubt, sadness and powerlessness as part of their grief experience. A third of the respondents talked about feelings of guilt, loss of sleep and crying.
• Participants widely reported hiding their grief from others because showing emotion was considered a sign of weakness. For many, the study interview marked the first time they spoke about such emotions at all.
• Half of the oncologists said that discomfort with their grief over patient loss could affect their treatment decisions with other patients, such as by providing more aggressive chemotherapy or recommending further surgery instead of palliative care even when treatment is futile. At least one other doctor acknowledged undertreating a patient after seeing another with severe toxicity.
• Half of participants admitted withdrawing from patients, in the form of fewer bedside visits and less overall interaction, as the patients got closer to dying.

Unease with losing patients also affected the doctors’ ability to communicate about end-of-life issues with patients and their families. Half of our participants said they distanced themselves and withdrew from patients as the patients got closer to dying. This meant fewer visits in the hospital, fewer bedside visits and less overall effort directed toward the dying patient.

It’s worth stressing that most physicians want what is best for their patients and that the outcome of any medical intervention is often unknown. It’s also worth noting that  physicians who are dealing with end-of-life issues are right to put up some emotional boundaries: no one wants their doctor to be walking around openly grief-stricken.

The research indicates that grief is having a negative impact on physicians’ personal lives and that there is a troubling relationship between doctors’ discomfort with death and grief and how patients and their families are treated. Physicians are not trained to deal with their own grief, and they need to be. In addition to providing such training, we need to normalize death and grief as a natural part of life, especially in medical settings.

To improve the quality of end-of-life care for patients and their families, we also need to improve the quality of life of their physicians, by making space for them to grieve like everyone else.