Patient deaths often have a significant emotional impact on physicians and other healthcare providers, particularly those early in their training.[i], [ii], [iii]
In one study of third year medical students, the majority of students reported having a strong emotional response to patient deaths, however 63% reported that there was no discussion or debriefing regarding the death with their team and no structured resources were provided for coping with the loss. Furthermore, many students identified their team’s lack of acknowledgement and insensitivity towards the death as a factor that prevented them in seeking support from their seniors and attendings.[iv]
In a qualitative study of medical students in their internal medicine clerkships, students expressed a desire for implicit or explicit acknowledgement of patient deaths by their medical team. Many students looked to the emotional responses of their seniors and attendings for cues regarding appropriate behavior following a patient death.[v] Both studies point to a process of ‘medical socialization’ that occurs among trainees, often as a results of an informal or ‘hidden’ curriculum that emphasizes detachment and depersonalization as strategies for coping with loss.[vi]
Limited data suggests that unaddressed distress caused by exposure to morbidity and mortality in medicine may contribute to empathy decline over the course of training.[vii] The emotional toll of patient deaths had been identified as a contributor to stress and burnout among practicing oncologists.[viii]
Despite the ubiquity of death in medicine, no standardized method of dealing with the emotional impact of patient deaths exists. Some research suggests that brief, real-time, supportive interventions can help address the negative impact of death on physicians.[ix], [x] ,[xi]
We believe that The Paper Cranes Project has the potential to serve this need.
[i] Redinbaugh EM, Sullivan AM, Block SD, et al. Doctors’ emotional reactions to recent death of a patient: cross sectional study of hospital doctors. BMJ. 2003;327:185-189.
[ii] Jackson VA, Sullivan AM, Gadmer NM, et al. “It was haunting . . .”: physicians’ descriptions of emotionally powerful patient deaths. Acad Med. 2005;80:648-656.
[iii] Moores TS, Castle KL, Shaw KL, et al. “Memorable patient deaths”: reactions of hospital doctors and their need for support. Med Educ. 2007;41:942-946.
[iv] Rhodes-Kropf, J., Carmody, S. S., Seltzer, D., Redinbaugh, E., Gadmer, N., Block, S., et al. (2005). This is just too awful; I just can’t believe I experienced that . . .: Medical students’ reactions to their “most memorable” patient death. Academic Medicine, 80(7), 634-640.
[v] Ratanawongsa, N., Hauer, K. E., & Teherani, A. (2005). Third-year medical students’ experiences with dying patients during the internal medicine clerkship: A qualitative study of the informal curriculum. Academic Medicine, 80(7), 641-647.
[vi] Pessagno R, Foote CE, Aponte R. Dealing with death: medical students’ experiences with patient loss. OMEGA-J Death Dying. 2014;68(3):207–28
[vii] Werner ER, Korsch BM. The vulnerability of the medical student: Posthumous presentation of L. L. Stephens’ ideas. Pediatrics. 1976;57:321–328.
[viii] Lyckholm L. Dealing with stress, burnout, and grief in the practice of oncology. Lancet Oncol. 2001;2:750-755.
[ix] Strote J, Schroeder E, Lemos J, Paganelli R, Solberg J, Range Hutson H. Academic emergency physicians’ experiences with patient death. Acad Emerg Med. 2011;18(3):255–260.
[x] Khaneja S, Milrod B. Educational needs among pediatricians regarding caring for terminally ill children. Arch Pediatr Adolesc Med. 1998;152(9):909–914.
[xi] Eng J, Schulman E, Jhanwar SM, Shah MK. Patient Death Debriefing Sessions to Support Residents’ Emotional Reactions to Patient Deaths. J Grad Med Educ. 2015 Sep;7(3):430-6