The death of a patient can mark the end of a long professional relationship, but there’s been surprisingly little research into what doctors do on such occasions, or what is expected of them.
A systematic review by a group of Victorian doctors has found only a handful of studies into the responses to a patient death by medical professionals and healthcare institutions, and with much of the research in the area focusing on commentary and anecdotal reports rather than quantifying the actions taken.
Letters and phone calls to family members were the most commonly cited responses in studies of doctors reactions to the death of a patient. However, practices varied widely by speciality, age and gender of the practitioner, according to the review by Dr Laurence Weinberg and colleagues at the Austin Health Department of Anaesthesia.
Unsurprisingly, doctors in specialities that deal more with end-of-life care such as palliative medicine, oncology and intensive care were the most studied when it came to bereavement practices.
While some doctors thought that a letter of condolence to family was appropriate, others believed that a phone call was a more immediate and personal way of providing a response to the death of a patient. Phone responses could be either active or passive, and depended on the level of services provided by the institution, with some hospitals having dedicated bereavement services and co-ordinators for family members.
Female doctors and doctors with more experience in practice were more likely to provide active responses to a patient’s deaths, but only a minority said they attended memorial services or a funeral.
Doctors who developed a special or longstanding bond with patients were more likely to be involved in bereavement activities – particular in specialties such as paediatrics and primary care.
“Funeral attendance was seen as an opportunity for closure of professional relationship,” noted the authors of an Australian study.
“Promoters of funeral attendance include attending funerals as an aspect of self-care and to show respect to the family,” they wrote in the journal Medicine.
But many doctors had mixed feelings about engaging too much with families, partly because of concerns about crossing professional boundaries, and because it might appear as an admission of failure or contribute to emotional burnout.
Time pressures and personal discomfort in dealing with death were other commonly-cited reasons for doctors to be less involved in active bereavement responses after a patient died.
The study authors said their review had shown there were significant gaps in the research into bereavement practices provided by hospitals and medical practitioners, particularly in specialists outside of palliative care and oncology.
“Future studies of a quantitative nature are needed for an in-depth study of the topic, such as meta-analysis of factors that influence medical practitioners’ involvement in bereavement practices,” they concluded.