What is it like to experience a patient’s death?
It almost goes without saying that every doctor will react differently to the death of a patient, depending on their level of experience, specialty, personality, and countless other factors. And every patient’s death will be different and significant in its own way.
The area of medicine a doctor works in is likely to make a considerable difference. An ENT specialist is unlikely to experience death frequently in their day-to-day, so if it does happen, it might have more of an impact. Emergency medicine may involve more frequent encounters with death, sometimes traumatic. Palliative care also involves a lot of contact with death, but it is expected.
For a profession where, in most roles, “saving lives” is part of the job description, the death of a patient is very likely to be bound up with feelings of failure. This can lead to a loss of confidence that affects a doctor’s work.
Doctors may feel guilty if they think they did not do enough to save a patient – or angry, if they feel their colleagues did not do enough. The death of a patient may also trigger past feelings of bereavement, of a relative for example.
Richard, a GP of 30 yearsThe ones I do feel and remember most are when the patient is a child, when I was present at the moment of death, or when I had a high degree of involvement and attachment preceding the death. Also especially when there was an error or delay in the care of the patient. This really fuels the guilt.
It is important to remember that no doctor can save every patient, no matter how much they have trained or how hard they work. Death is a part of life, and it is a part of medicine.
Doctors have to learn how to remain compassionate and empathetic, while not letting their emotions prevent them from doing their job. Coping with patient death is one component of this balancing act.
Coping with your first patient death
Most doctors will first experience a patient dying while they are still a student. Medical school is a demanding, competitive environment, and students are understandably wary to show any weakness. But it is only natural to experience difficult emotions when someone dies, and it doesn’t mean that you aren’t cut out for the job.
Try to acknowledge those emotions, rather than shutting them off. It can also be helpful to talk to someone. This might be a trusted friend, or a more experienced colleague. But remember that they are only human too, and your colleagues will very likely have had painful experiences of their own around the death of a patient.
You may also have to comfort a patient’s loved ones while you are experiencing grief yourself. It’s OK to be human and show emotion in this situation, and it may even be helpful to them, but be careful not to put your grief over theirs.
Strategies for coping with death during your medical career
Doctors know very well that prevention is better than cure, and the best way to cope with the death of a patient is to take care of yourself. If you are already struggling, the death of a patient may well hit you harder than it normally would.
The best way to prepare yourself for difficult situations like the death of a patient is to try and reduce your risk of stress and burnout. These issues are sadly very common among doctors, but they are not inevitable and there are ways to mitigate them.
This can start with self-care. Having strategies that you can employ yourself to relieve stress and pressure is vitally important. But while self-care is important, it’s not realistic to expect that you can cope with the death of a patient all on your own, and it’s important to know what sources of support you can call upon and when.
Informal support from colleagues, like a chat over a cup of tea, is valuable and should not be discounted. Sometimes more formal support will be appropriate: this might be available through your hospital or NHS Trust. Or you may want to talk to your GP if you feel patient death is seriously affecting you.
How to know when you need support
Anyone who witnesses death frequently can become desensitised to it. And it is true that in situations where death is common, some level of desensitisation can be beneficial for survival. But in the long term, desensitisation can harm your mental health and your relationship with others. It’s better to try and find healthy ways to cope with the emotions that come with the death of patients, rather than relying on “switching them off”. If you feel you are becoming numb or desensitised, it is important to seek support sooner rather than later.
Our Vital Signs guide gives advice for doctors experiencing stress and pressure, including seven key early warning signs that you might not be coping well at work.
What support is available?
If you are facing financial hardship due to mental health issues caused by patient death, you may be eligible for financial support from the RMBF.
DocHealth, provided by the RMBF and the BMA, offers confidential psychotherapeutic support for all UK doctors.
Rightsteps is an online wellbeing platform that can help with issues including stress and anxiety, and this website offers a hub with helpful articles covering wellbeing and other issues for doctors.
As mentioned, there may be support available through your workplace or your GP. The BMA offers free and confidential 24/7 counselling and peer support services to all doctors and medical students (regardless of BMA membership), plus their partners and dependents. The royal colleges and other professional organisations for doctors also offer a range of support programmes.