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Doctors’ emotional reactions to recent death of a patient: cross sectional study of hospital doctors
Ellen M Redinbaugh, Amy M Sullivan, Susan D Block, Nina M Gadmer, Matthew Lakoma, Ann M Mitchell, Deborah Seltzer, Jennifer Wolford, Robert M Arnold
Department of Behavioural Medicine and Oncology, University of Pittsburgh Cancer Institute, 5150 Centre Ave [445, Pittsburgh, PA 15232,USA Ellen M Redinbaugh research instructor Division of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Department of Psychiatry, Harvard Medical School, 44 Binney St, Boston, MA 02115, USA Amy M Sullivan assistant professor Susan D Block associate professor Nina M Gadmer project manager Matthew Lakoma research assistant University ofPittsburgh School of Nursing, 415 Victoria Building, 200 Lothrop St, Pittsburgh, PA 15213, USA Ann M Mitchell assistant professor Department of Internal Medicine, University of Pittsburgh School of Medicine, 200 Lothrop St, Pittsburgh Deborah Seltzer research associate Jennifer Wolford research assistant Robert M Arnold professor Correspondence to: E M Redinbaugh ellenr@pitt.edu
bmj.com 2003;327:185Abstract
Objectives: To describe doctors’ emotional reactions to the recent death of an “average” patient and to explore the effects of level of training on doctors’ reactions. Design: Cross sectional study using quantitative and qualitative data. Setting: Two academic teaching hospitals in the United States. Participants: 188 doctors (attending physicians (equivalent to UK consultants),residents (equivalent to UK senior house officers), and interns (equivalent to UK junior house officers)) who cared for 68 patients who died in the hospital. Main outcome measures: Doctors’ experiences in providing care, their emotional reactions to the patient’s death, and their use of coping and social resources to manage their emotions. Results: Most doctors (139/188, 74%) reported satisfyingexperiences in caring for a dying patient. Doctors reported moderate levels of emotional impact (mean 4.7 (SD 2.4) on a 0-10 scale) from the death. Women and those doctors who had cared for the patient for a longer time experienced stronger emotional reactions. Level of training was not related to emotional reactions, but interns reported needing significantly more emotional support than attendingphysicians. Although most junior doctors discussed the patient’s death with an attending physician, less than a quarter of interns and residents found senior teaching staff (attending physicians) to be the most helpful source of support. Conclusions: Doctors who spend a longer time caring for their patients get to know them better but this also makes them more vulnerable to feelings of loss when thesepatients die. Medical teams may benefit from debriefing within the department to give junior doctors an opportunity to share emotional responses and reflect on the patient’s death.

and stress caused by caring for dying patients.1 2 Such stress has been linked to professional burnout and may put doctors at risk of psychiatric disorders.3–5 Previous research has linked level of training withdoctors’ emotional reactions to deaths. In a longitudinal study “dealing with death and dying” was the most commonly reported source of stress among junior house officers,6 and it was related to psychological distress.7 As general practitioners, these same doctors did not find death and issues around dying to be stressful.8 These data provide some general expectations about emotional differences betweenjunior hospital doctors and attending physicians (consultants). However, little has been published on junior doctors’ use of coping strategies and social resources to manage powerful feelings evoked by their work. We sought to extend previous research by investigating doctors’ reactions to patients’ deaths in two large US teaching hospitals. We explored the role of training level and other...