NLM Director’s Comments Transcript
How Grief Impacts Physicians: 07/23/2012

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Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.

Grief after the death of patients impacts the professional and personal lives of some cancer specialists, finds an illuminating and pioneering qualitative study recently published in the Archives of Internal Medicine.
The research, based on in-depth interviews with 20 Canadian oncologists (cancer specialists), finds when patients die, physicians experience occasional sadness, crying, loss of sleep, and sometimes feel remorse (intertwined with introspection) about past clinical decisions.
The study found other powerful emotions after a patient’s death (among the interviewed oncologists) included: powerlessness, self-doubt, guilt, and a sense of failure.
The study, which is the first qualitative assessment of grief-related issues in medical practice, suggests bereavement after patient deaths is an ongoing personal and professional challenge for some physicians. The study suggests some oncologists struggle to establish emotional boundaries so grief about a dead or dying patient does not impede their ability to treat others or impact their personal life.
In a commentary about the research in the New York Times, the lead author concedes the study provides a novel focus on physicians’ grief instead of emphasizing bereavement among a patient’s family and friends. Yet, Leeat Granek Ph.D., a psychologist at Toronto’s Hospital for Sick Children, notes grief about a patient’s death is an underappreciated byproduct of medical practice and patient care.
Dr. Granek writes in the New York Times (and we quote): ‘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’ (end of quote).
For example, the study finds some oncologists distance themselves or withdraw after patients die, or once patients get closer to death. The study reports the result is (and we quote): ‘fewer visits in the hospital, fewer bedside visits, and less overall energy expended toward the dying patient’ (end of quote).
While the authors emphasize the study’s findings are not generalizable, the study suggests bereavement boundaries are an elusive, latent psychological challenge for some physicians.
The study concludes (and we quote): ‘one way to begin to ameliorate these negative effects would be to provide education to oncologists on how to manage difficult emotions such as grief starting at the residency stage and as continuing education throughout their careers, with the recognition that grief is a sensitive topic that can produce shame and embarrassment for the mourner’ (end of quote).
Meanwhile, MedlinePlus.gov’s bereavement health topic page provides some helpful resources if you experience grief. An overview of grief’s stages as well as some therapeutic suggestions are provided by the American Hospice Foundation within the ‘overviews’ section of MedlinePlus.gov’s bereavement health topic page.
A guide to address some complex grief-related challenges is provided by the Mayo Foundation for Medical Education and Research within the ‘specific conditions’ section. For caregivers, there are links to resources that can help you support a grieving parent, friend, co-worker, sibling, among others. These resources are available in the ‘related issues’ section of MedlinePlus.gov’s bereavement health topic page.
MedlinePlus.gov’s bereavement health topic page additionally contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the bereavement health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.
To find MedlinePlus.gov’s bereavement health topic page, type ‘grief’ in the search box on MedlinePlus.gov’s home page, then, click on ‘Bereavement (National Library of Medicine).’
MedlinePlus.gov also features a related, helpful health topic page on end of life issues.
Finally, the oncologist interviews reveal new insights into grief’s multidirectional impact and reinforce the need for all of us to find refuge and therapeutic options following a loss.
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A disclaimer – the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider. I want to take the opportunity to wish you a very happy holiday season and a healthy New Year. The National Library of Medicine and the 'Director's Comments' podcast staff, including Dr. Lindberg, appreciate your interest and company – and we hope to find new ways to serve you in 2012.
I look forward to meeting you here next week.