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Should doctors attend patients’ funerals?

Doctor grieving after the death of a patient

How common is it for a doctor to attend their patient’s funeral? Not every doctor chooses to, and, needless to say, a doctor certainly can’t attend the funeral of every patient she or he has cared for. However, in certain cases, the doctor may be grieving, or feel it is appropriate to pay their respects to a patient, for example if they have cared for them for a long time through a serious illness. A newly-published paper has found support for these long-held assumptions.

Most importantly, the research found that many doctors are still not comfortable discussing attendance at a patient’s funeral with their colleagues. Those who are able to discuss such things are significantly more likely to attend a patient’s funeral, compared to those who feel unable to open up to their fellow doctors.

“Doctors are taught from their very first year that in order to survive, they need to be objective,” says psychologist Dr Sofia C. Zambrano. “They are not allowed to cry, they are told that they have to go and hide somewhere if they are crying, or that they need to pull themselves together. Doctors are expected to not to show any emotions around their patients.

“There seems to exist a culture of toughness where you are expected to deal with everything on your own and to not show weakness. It is then not a surprise to see that physicians have high rates of burnout, depression, substance abuse and even of suicide. Doctors don’t talk to each other, even though they are the ones who can understand each other the most.”

Dr Zambrano conducted a research study at the University of Adelaide, looking into funeral attendance practices of Australian health professionals. She and her colleagues, Anna Chur-Hansen and Gregory B. Crawford, created an online survey, which was answered by 437 doctors across the country, from various different specialties (they also targeted other health professionals like nurses and social workers, however that is the subject of an upcoming publication). The aim of the survey was to explore, what perceptions doctors have of attendance, how often they attend their patients’ funerals – and what influences them to do so.

“It all started with how often funeral attendance was mentioned by the physicians I had interviewed for my Master’s degree, which was on GPs experiences of the death of their patients. Later on, as part of my PhD thesis looking into how oncology, intensive care, surgery, and palliative care doctors coped with the experiences of providing end of life care, the topic continued to be brought up by participants,” she explains.

“What I found interesting is that when the physician attends the funeral, it is not just about that sense of the physician feeling better about themselves, and dealing with their emotions, but also that sense of wanting to do something for the family, showing that they had a relationship that was important to them. It’s not just about the physician, but for the benefit of the family.”

For example, the doctor’s attendance, apart from helping the doctor cope with the grief of losing a patient, may signal to the bereaved family that support is still available. It can bring some comfort too, and give the message that the patient who has died had a valuable relationship with their doctor.

There are no official rules that prevent doctors and other healthcare workers from attending patients’ funerals, but often it is seen as crossing a line between professional and personal lives. This means that many doctors feel unable to openly discuss the topic with their colleagues, as Dr Zambrano’s study revealed.

Key findings of the study

When asked whether they had ever attended a patient’s funeral, the results showed a huge variation between doctors of different specialties.

The majority of GPs, 71%, had attended at least one patient’s funeral in the past. 67% of oncologists, 67% of psychiatrists, 63% of palliative medicine specialists, and 52% of surgeons had also attended a funeral. However, only 22% of intensive care specialists surveyed said they had been to a patient’s funeral.

Dr Zambrano points out that there may be many different reasons, personal, cultural and professional, why some doctors choose to go to certain patients’ funerals and some doctors never have. One of these reasons is peer perception.

“Peer perception is basically the way that physicians see other physicians,” Dr Zambrano explains. “If they perceive that the colleagues would criticise their attendance, they are less likely to attend the funeral, and they won’t talk about it with colleagues.”

Responses to the survey show that because of the silence around the topic of funeral attendance and reactions to death in general, doctors do not feel able to talk to each other about these shared experiences:

“On the one hand, those participants who had never attended a funeral had had significantly fewer discussions with colleagues about funerals and also perceived colleagues as disapproving of funeral attendance. In contrast, discussions with colleagues and the perception of a work culture that supports funeral attendance were found to encourage attendance, along with attendance as a self-care practice and wanting to show respect to the family.”

Put another way, the openness of a person’s fellow physicians and colleagues, and what the person feels is the general opinion about funeral attendance among them, has a direct impact on whether or not they attend a patient’s funeral. This may be linked to expectations placed on doctors to behave in a certain way, by hiding their emotions from patients and other medical professionals.

Gender differences

Notably, the survey found some differences between genders. “Women physicians were more open to talking about funeral attendance with peers, felt that they were allowed to cry, and were more likely to attend funerals because they experienced grief after the death of some patients,” says Dr Zambrano.

Previous research from the 1970s showed little difference in emotional reactions between male and female doctors. However, as Dr Zambrano points out, the professional atmosphere at the time might have meant women were more guarded about acting in stereotypically feminine ways, such as crying. Nowadays, it is a “widely acknowledged view that women in medicine can behave differently to men” and it is more acceptable now for women doctors to show their emotions in a medical setting.

Though this might represent a positive change for female doctors, could this mean that male doctors still feel pressured to conceal their emotions after the death of a patient? While female physicians are more open to discussion, perhaps conversation needs to be encouraged among male healthcare professionals.

Going forwards

Dr Zambrano, Chur-Hansen and Crawford’s study doesn’t draw any conclusions about whether or not funeral attendance is definitely beneficial to the doctor or family. However, it does call for the medical community to “ask itself whether funeral attendance needs to – and can – be addressed more openly, whether death and dying should be discussed more candidly among health professionals, and what effects these discussions may have on job satisfaction and on the mental health of medical practitioners.”

During their research, the team also talked to other health professionals including nurses and social workers and these findings will be the subject of a further publication.

Dr Zambrano believes that the way forward is to further understand these phenomena, and to break down any taboos that prevent doctors from discussing these topics with their colleagues. This is the main focus of one of her current research projects as a Postdoctoral Researcher at the Palliative Care Centre from the University Hospital of Bern in Switzerland, a project recently funded by the Swiss National Foundation to explore these issues across different countries.

“We cannot just target the training of the junior physicians, because those behaviours may be changed once they enter the hospital,” she explains. “In a way, what we advocate is that we focus as well on those older physicians, those who are already practising, because they are the ones who can actually affect the way that the younger generations of physicians may relate to this topic. Really, this is something that should be talked more openly about.”

Like so many issues relating to death and grief, it seems that the problem comes from not talking about it enough. Hopefully future research will develop strategies to help all healthcare professionals talk more openly about the emotional challenges of coping with a patient’s death.

You can purchase a digital copy of ‘Attending Patient Funerals: Practices and Attitudes of Australian Medical Practitioners’ from Taylor & Francis Online, or you can request a copy from one of the authors. Read more about coping with the death of a patient.

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