One of the most difficult and sensitive roles of a physician is dealing with a grieving patient. The way in which you respond can have a profound effect on patients. Their psychological well being and the quality of their ongoing relationship with you are at stake. We outline below five things which physicians should never say to a grieving patient, how a grieving patient would most likely respond, and our own summary of the exchange.
- Doctor – “I know exactly how you feel”
- Patient – “No you don’t. You don’t have what I have. Anyway, nobody knows how I feel. Just because you may have dealt with lots of people in my position, you shouldn’t assume that we’re all the same, and you don’t even know me that well anyway.”
The Grief Recovery Institute, which has been helping grieving individuals for over 35 years, has determined that the most hurtful comment for thousands of people following loss was “I know how you feel.” People frequently feel robbed of their dignity and the uniqueness of their situation after hearing that phrase. Every grieving situation is different, and while some physicians may be able to “relate to what someone else is going through,” they can never truly know what the other person is feeling.
Grieving patients are more likely to respond positively to doctors who state that they cannot imagine what they are going through or that they cannot imagine how they must be feeling but will be there for them to listen and provide support.
- Doctor – “It’s not the end of the world”
- Patient – “I know it’s not the end of the world, but it’s the end of my life as I know it. It’s the end of all of my plans and dreams. My world, contrary to what you might think, has stopped turning. People keep telling me that life goes on, but to me, that is the saddest part. “
When managing their grief, patients will rarely look beyond their own personal lives. However minor the medical condition or circumstance giving rise to their grief might be, the patient may consider it to be life-changing and, for them, an abrupt and permanent end to the world that they had previously inhabited.
- Doctor – “Try to be strong/think positively”
- Patient – “Why should I try to be strong and what do I have to be positive about? I don’t feel very strong at the moment and who are you to tell me that I should? What I’m going through is anything but a positive experience.”
Strength comes from within and telling a patient to be strong is pretty meaningless. In addition, some patients may react to advice to be positive by internalizing their grief, which, although giving the appearance of “being strong” is an unhealthy response to grief.
- Doctor – “Actually, things could be a lot worse”
- Patient – “That may be true, but it doesn’t make me feel better to hear it because my condition could also be a lot better or I could have no health issues at all!”
Grieving patients derive little or no consolation from the fact that their position could be even worse. The natural reaction is to consider things from the reverse viewpoint and grieve their condition from the stance that things could be infinitely better.
- Doctor – “You’re young enough to have another child”
- Patient – “I don’t want another child. I want the child that I have lost. It doesn’t matter how old I am. I’ll grieve the loss of my child forever and, even if I do have another, it will never be a replacement.”
Dealing with a patient who is grieving the loss of a child requires the greatest degree of sensitivity. Any suggestion, however remote, that a deceased child can somehow be replaced should be avoided at all costs. Before you tell a grieving parent to be grateful for the children they have, think about which one of yours you could live without.
As a medical provider, it is inevitable that you will encounter grieving patients. Listening to these patients, being available for them, not pressuring them to end their grieving process, not judging them, sending them sincere hand-written cards, sharing memories, and offering them concrete and useful resources to help them through this difficult time can be extremely comforting to patients. Applying understanding, sensitivity and respect for the patient as an individual – which means avoiding the five types of exchanges outlined in this article – can be invaluable for both the patient and the doctor.
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