title: Physicians' Reflections on Death and Dying on Completion of a Palliative Medicine Fellowship.
abstract: BACKGROUND
  Patient and family dissatisfaction may result when they are not satisfied with the physician/patient interaction, although the physician may feel he/she worked hard to provide information to the patient and family. New approaches to visual analysis can (1) identify significant insights from physicians' personal and clinical experiences in providing compassionate palliative care and end-of-life care and (2) provide an effective and practical vehicle for communicating with patients, their families, and other professional caregivers.
  
  
  OBJECTIVE
  To elucidate palliative physicians' core experiences with their patients' dying and death.
  
  
  METHODS
  A qualitative visual analysis was conducted on 75 images created by physicians completing a one year palliative medicine fellowship. These images are part of a larger personal reflections narratives database of images, text, and auditory projects prepared by students, interns, and fellows completing training in palliative care at a large hospice provider. Participation in the personal reflections project is a required part of the training program, with the goal of blending clinical competencies with lived experiences of caring for the dying.
  
  
  RESULTS
  Two categories of visual metaphors underlying the images were identified, with both expressing the relationship and transitional dynamics of life and death: portraits (n = 30, 40%) and nature (n = 45, 60%). Conventional images representing anxiety, pain, or other dimensions of suffering commonly associated with death and dying were virtually absent (n = 2, 0.03%).
  
  
  CONCLUSIONS
  We propose the communication of positive, hopeful, even peaceful perceptions of death and dying was likely the result of effective personal and professional skills gained through physicians' clinical experiences during the fellowship.
authors.affiliation: University of Calgary, Calgary, Alberta, Canada. Electronic address: barnold@ucalgary.ca.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Arnold
authors.affiliation: Public Health Consultant, San Diego, California, USA.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Lloyd
authors.affiliation: OhioHealth, Columbus, Ohio, USA.
authors.forename: Charles F
authors.initials: CF
authors.lastname: von Gunten
mesh_terms: D001293:Attitude to Death; D004503:Education, Medical, Graduate; D006801:Humans; D008091:Literature; D033262:Narration; D010151:Paintings; D010166:Palliative Care / Q000523:psychology; D065126:Palliative Medicine / Q000193:education*; D010775:Photic Stimulation; D010820:Physicians / Q000523:psychology*; D011787:Quality of Health Care; D012189:Retrospective Studies; D012649:Self Concept
keywords: Palliative care; humanism; physicians; self-reflection; visual narratives