It is the nature of our work that we have the opportunity to be involved in the medical and surgical management of chronically ill patients, and sometimes these patients die. If you have not experienced this yet, you will, and it will change you, perhaps more than you know, or will know, at the time.
Throughout my residency training, I was involved in the care of three patients who died. One was a trauma patient involved in a MVA, One was a patient with gas gangrene and sepsis from a diabetic foot wound, and one was end-stage renal disease from SLE. There was no malpractice, or malfeasance; it was just bad luck for those patients. I remember at the time wanting to say something or do something for the families of those patients – wanting to reach out to them in someway, but not knowing whether or not it was appropriate, or even what to say. I really just wanted to convey something to them in their time of grief.
In the 19th century, letters of condolence were considered part of the physicians responsibility. However, as time progressed, clinicians have become Interestingly insulated from their patient under the guise of professionalism and of course, the writing of a condolence letter requires the physician to overcome their own sense of loss, or failure.1
Interestingly, a recent search on Pubmed demonstrates that the concept of writing letters of condolence is demonstrating resurgence in the scholarly journals. A consensus within the current literature suggests that it is not only appropriate for a clinician involved in the care of patients who ultimately pass write a condolence letter to the family, but that doing so is indeed part of the clinicians professional responsibility to the patient.2, 3 More than that, such a letter provides a "model of humanistic behavior for nurses, office staff, and residents and fellows," and demonstrates how we as humans SHOULD interact with one another. Furthermore, a well thought-out letter can have a positive effect on grieving family and can help them to cope with their loss and their prospects of the future.3, 4
You do not have to have any answers. The simple act of offering your condolences will be greatly appreciated and provide comfort. The content does not have to be overly personal or familiar, either. You should acknowledge the loss, refer to the deceased by name and perhaps offer some sentiment about hopes for the family's well being. I would encourage you also to hand write the note on a card, rather than typing a letter on your office stationary. It is personal attention to detail that demonstrates sincerity and will be appreciated by the family members.
As I have a gotten older, I have experienced more personal losses while also maturing in my clinical practice, and as a consequence of this growth, I can increasingly see the value in maintaining my humanity in my interactions with my patients and their families, particularly when I share with them some of the most profound moments of life and death. In a world where medicine has become progressively shaped by technological advancements in patient care, we cannot allow ourselves to become simply technicians of these grand new machines — cold professionals who can render no comfort.
It is our humanity alone that will matter most to our patient’s and their families in those moments of loss and grief. As you proceed through your residency training and into clinical practice, you will be faced with these challenging situations, and I would encourage each of you to open yourself up to everything those moments have to teach you – they will be invaluable in shaping you into the clinician you will become.
References:
- Seravalli, E.P., The dying patient, the physician, and the fear of death. N Engl J Med, 1988. 319(26): p. 1728-30.
- Musani, A., A dying art?: The doctor's letter of condolence. Chest, 2007. 132(5): p. 1718-9.
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Bedell, S.E., K. Cadenhead, and T.B. Graboys, The doctor's letter of condolence. N Engl J Med, 2001. 344(15): p. 1162-4.
- Brennan, M., Condolence books: language and meaning in the mourning for Hillsborough and Diana. Death Stud, 2008. 32(4): p. 326-51.
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