Originally Posted by Archaeopteryx
I was wondering about this issue, and I Googled it and couldn't find anything helpful. So I thought you guys might have some ideas about it.
Do medical schools train students how to deal with situations when they fail to save a patient's life? or how to break the news to the family?
Yes, I know medical schools are supposed to select and build strong characters. But I can't imagine it to be an easy task for any person to cope with death after being trained for years to prevent it.
So back to the original question, do they have some sort of a class for that? or do they leave it for experience?
I will tell you about my experiences - I'm a critical care (ICU) fellow so I deal with this fairly often. I suppose we got some training on this in med school but it's not really something that goes easily into a powerpoint lecture.
The magnitude of my emotional response to a patient's death seems to depend on how long I've been caring for them, the severity of their illness (how much I could see it coming,) and other factors, such as their age. I'm not saying one death is better or worse than another (or more or less sad), just that some factors seem to produce a larger emotional response. Obviously, the longer I've known the patient, the more I've connected with them and their family. If a patient has a terminal illness that has been progressing over months, we can prepare for the likelihood/inevitability of their death. And it tends to be easier to rationalize/intellectualize deaths in older patients. I'm not saying it's still not sad. So it tends to be that the most emotionally upsetting deaths are in young, previously healthy patients. I am thankful that I only care for adults - I don't think I could handle the death of a child.
I think it's good to feel a range of emotions. Would it be inappropriate to feel good when a sick patient gets better? Why should it be bad to feel sad when one dies? As long as it doesn't keep you from caring for other patients. It's hard to say if it gets easier to deal with death over years of a career. I had deaths that were upsetting as an intern. Five years later, I've also had patient deaths that were upsetting to a similar degree.
People become doctors because they care about human life and want to help people. I think it's a natural reaction to have a range of emotions when someone who you want to help dies. I don't think it would be good to ignore or suppress that. I prefer to acknowledge it, think about it in context, and reflect on what could have been done differently.
Most of the deaths I've dealt with in the ICU were incredibly ill patients - multisystem organ failure, on ventilators, multiple pressors (drugs to keep the blood pressure up), dialysis, etc. Their outlook was very poor. In the unlikely event they had ended up surviving their illness, they would have faced a poor quality of life. I can look to these facts to help ease (rationalize) the impact. But then I talk to their famly and no longer see numbers or machines, I see the human impact on the loved ones who are affected.
I think the best I can do as a doctor when someone is going to die (after all medical options have been exhausted) is to try to allow them to die with some dignity, and keep the family informed to how their loved one is doing.