Doctors and Dieing Patients

“A physician’s responsibility for the care of a patient does not end when the patient dies. There is one final responsibility – to help the bereaved family members. A letter of condolence can contribute to the healing of bereaved family and help achieve closure in the relationship between the physician and the patient’s family”, says an article in the New England Journal of Medicine (NEJM).

How often do we, the physicians, do this? Hardly ever. Well, I shouldn’t say that! There is always some body somewhere who does special things for people he cares about. Let me tell you about my own practice and how things have evolved over the years. This is not only about bereavement. It is also about caring and making patients feel good.

Let me start with a recent example. A patient who I had known for many years was hospitalised with complications from a long-standing illness. I was not directly involved in her care, but I knew she was in the hospital. From time to time, I dropped in to say hello, held her hand and spent few minutes talking about things in general.

Few days later, she died. I received a “thank you” card from the family for having taken care of her in the past and how much my visits and services were appreciated by the patient and the family. I asked my receptionist to give me her file so I could call the family and give my condolence. The file lay on my desk for two weeks and I never got around to phoning.

This is in complete contrast to what I used to do when I started practice 16 years ago. I had no children, my practice was not that busy and I had plenty of time to spend with my patients and their families.

I used to do my ward rounds twice a day. Morning rounds are usually “quickies”, as we are rushing to the office, or to the operating room. Evening rounds allowed me to sit with my patients and learn more about their illness and family. Occasionally, I sent flowers to patients who I had known who had major surgery. Some times my wife visited them in the hospital.

On weekends, I used to take my 5-year-old son to meet my patients. We had a white coat made for him and he would carry his plastic stethoscope in his pocket. Many of my patients still remember this. Even now they ask me how is my little boy doing (he is 14 now!). Few years later I started taking my daughter as well. Some time it was hard to control both and I heard a nurse say, “I didn’t know doctor’s children can be naughty!” That put an end to my family ward rounds on weekends!

As I got busy with my practice and my family, the evening rounds occurred only if a patient was sick and needed another visit to check his progress. The desire to rush home and play with my kids was irresistible after a long day in the hospital and office.

In the last 16 years, I don’t remember having written a letter of condolences to bereaving family members. Occasionally, I have phoned. Contact with the patients in hospital is now to a minimum. Most patients are discharged the same day or day after surgery. Due to long waiting lists, the pressure to see more patients in the office does not allow too much time to talk about other things. As a specialist, it is hard to know my patients more than what they come to see me for. That old style “family physician” type of relationship is hard to establish.

The NEJM article says that in the 19th century America, the process of grieving was detailed and elaborate. The doctor’s letter of condolence was an accepted responsibility and an important part of the support offered to the bereaved. But today, the pattern of mourning has changed and has become much abbreviated.

But the article makes a strong point to encourage physicians to find time and write a letter to bereaved family. It says, “Unlike expressions of condolence made by telephone or in person, a letter of condolence is a concrete gift that the recipient can and will review over and over”. I agree. But will I be able to do it? Only time will tell.

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