"It was haunting...": physicians' descriptions of emotionally powerful patient deaths.
OBJECTIVE
To understand the emotional experiences of physicians who care for dying patients and to identify educational opportunities for improving patient care and physician well-being.


METHODS
Between 1999-2001, physicians at two quaternary care medical centers in Boston, Massachusetts, and Pittsburgh, Pennsylvania, participated in 90-minute, semistructured personal interviews on their most emotionally powerful patient death. Quantitative data was obtained through face-to-face surveys rated on ten-point scales that asked physicians about emotional characteristics of and emotional responses to the death. In the qualitative portion of the survey, physicians were asked to describe the details of the most emotionally powerful patient death, the types and sequence of their emotional reactions, their methods of coping, and subsequent changes in behavior.


RESULTS
Physicians had powerful experiences with death during all stages of their careers. Experiences with patient death generally fit into one of three types: "good," "overtreated," or "shocking/unexpected." Housestaff often described coping in isolation with the disturbing emotions generated in the care of dying patients. Physicians learned how to care for and cope with dying patients from their experiences with patients whose deaths were most emotionally powerful and reported changes in their clinical behavior and career paths as a result.


CONCLUSIONS
Physicians' emotional reactions to patient death can affect patient care and the personal lives of physicians. Supervising physicians have an opportunity to improve both the care of dying patients and house-staff coping with these deaths by using the "teachable moments" that are present for trainees as they care for the dying.
Jackson
Vicki A
VA
Massachusetts General Hospital, 55 Fruit Street, Founders 600, Boston, MA 02114, USA. vjackson@partners.org
Sullivan
Amy M
AM
Gadmer
Nina M
NM
Seltzer
Deborah
D
Mitchell
Ann M
AM
Lakoma
Mathew D
MD
Arnold
Robert M
RM
Block
Susan D
SD
D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D001900:Boston; D003142:Communication; D004644:Emotions; D019538:Health Care Surveys; D006801:Humans; D007407:Interviews as Topic; D008505:Medical Staff, Hospital / Q000523:psychology*; D010414:Pennsylvania; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D013727:Terminal Care / Q000523:psychology*