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machado: does a doctor's responsibility to a patient end with their death?
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the us national comprehensive cancer network recommends that health-care professionals communicate with the family and friends of the deceased. getty
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years ago, i was having dinner with a few doctors at a conference — all very nice people, passionate about their work and committed to their patients — when the topic of following up with loved ones after a patient passes away came up.
i had been telling them about the celebration of life i had been at for a wonderful woman i met through our patient group. though she had a different type of leukemia, she and her husband had attended our meetings and over the many months of her illness, they had become close with several people in the group.
her passing touched all of us in a it-could-have-been-me kind of way, but also because of all that we had been through with her and husband — the misdiagnoses, the medications that didn’t work, her fear — we felt close to her husband’s pain, loss and sadness. and when a few of us joined him to bid her farewell, he was not only grateful, but he said that hearing stories about her from people who really knew the challenges she faced helped him heal, and feel less alone.
“i have never gone to a patient’s funeral,” said one of the doctors as he stood up to go to the washroom, laying his white napkin on his chair. the woman to his right peeked over the top of a shiny menu to make a comment about her inability to get away from the office because she had so many patients, joking that maybe she needed to be more efficient with her time.
it turned out that among this bunch, attending patient funerals wasn’t a thing. in fact, not only had none of them ever been to a patient’s funeral, they also admitted to never reaching out to the families who were left — even the ones they had known for a long time. not a phone call, or a card, or even an email.
“it would be awkward,” said the man over his shoulder, as he headed to the toilet. “plus, when everything was over, would they really want to hear from me?”
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wouldn’t they?
i have been thinking about this conversation a lot lately after a friend of mine sent a note with a picture of the flower arrangement she received from the doctor who cared for her recently deceased father. he had been his patient for more than five years. the doctor knew each grandchild’s name and her father’s favourite singer. so it made sense that the arrangement came with a sweet note about a funny conversation he had shared with her dad — one of the last ones before he died, in fact. those few scribbled lines meant everything to my friend.
i had a similar feeling when i spotted a few of the personal support workers who had cared for my dad in the audience as i said the eulogy at his funeral. that they took time away from their work and families to be with us as we said goodbye was, in itself, so nice. but it also sent an important message to our grieving family — especially to my mom — that his life didn’t go unnoticed; that he was more than a just a job to them; that he mattered. and when your heart is broken and all you wish for in the entire world is to hear your loved one’s voice just one more time, it means a lot when the people from their life show up to stand with you.
a letter of condolence can contribute to the healing of a bereaved family and help achieve closure in the relationship between the physician and the patient’s family. getty
and sure, attending a funeral or a celebration of life is a big ask — of anyone, let alone someone who, as a medical professional, often awkwardly straddles the roles of caregiver, family acquaintance, hero. one who probably doesn’t have intimate knowledge of the patient, and yet has met partners and children, and most importantly, shared the final vulnerable moments of their loved one’s life. like the doctor at dinner said, it could be awkward.
but not even a card?
the last time i saw my brother alive, we were in an examining room with his specialist who had been treating him for about five years. he had other doctors too, but she was the main one, the one with the most expertise, the one who passed him a kleenex when tears rolled down his cheeks after she told him his prognosis. she was also the one who investigated new drugs and clinical trials, who offered encouragement and answered his emails. she knew about his children and joked about his tattoos. that day, she carefully promised that she’d try to give him a year.
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u.s. guidelines recommend health-care professionals communicate with family of the deceased
he died four days later unexpectedly, and we never heard from her again. my mom did, however, open an envelope about week afterwards to find a sympathy card from another doctor who had also known my brother. and despite the tears her words brought my mom, the card was a welcome reassurance that there were people who genuinely cared for her son. that he mattered.
i know many others who have also received notes of condolence — even charitable donations made — from health-care providers with whom a relationship grew out of a loved one’s illness. there’s no denying the benefit of this outreach to a grieving family — not only does it provide comfort, but it also shows that a doctor’s care doesn’t have to end with the death of a patient. in fact, should simply extend to the ones who are left.
in fact, according to guidelines from the us national comprehensive cancer network, which recommend that health-care professionals communicate with the family and friends of the deceased, these efforts to console not only provide comfort to the bereaved, but also ease the sense of abandonment they may feel after suddenly losing the relationship with the doctor. it does something else too: when doctors observe the loss of a patient along with their loved ones, it helps them to grieve as well, to process the loss — an opportunity that is not often had.
the importance of the condolence letter has also been extolled in a new england journal of medicine article in which the authors write, ”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 a bereaved family and help achieve closure in the relationship between the physician and the patient’s family.”
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i’m not suggesting that sending condolence letters and flowers be added to the already overflowing to-do list for health-care providers, but with all the good that can be had, i’m just curious as to why we don’t see more of this? along with screening reminders and new patient welcome notes, couldn’t we bake into our system a way to make it so that the act of healing doesn’t end cold turkey with death?
what we’d be talking about, then, is a model of care that acknowledges that healing and hope not only exist while sustaining life, but also when life ends.
sounds to me like it would be worth a little awkwardness.
lisa machado is the executive producer of healthing.ca. follow her @iamlisamachado.
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