Richard Vautrey: Grim reaper can take toll on doctors

Every day doctors have to tread a delicate line around how we deal with death.

We have to accept that lives end and understand our role in providing as good a death as possible for patients and their families.

But, at the same time, it is vital that doctors have the appropriate support and are not expected to be unaffected by what are incredibly difficult situations that often stay with you.

Sadly this is not always the case.

I recently heard the story of a doctor in Yorkshire who was working in a surgical specialty in their first year on the job, and was left alone to deal with a patient at the end of their life as the senior doctor was in theatre.

Earlier that morning, another doctor had given the patient and their family some good news regarding test results and suggested that the patient would 
live a little longer, so the rapid deterioration was completely unexpected, leaving the patient’s family completely unprepared.

The junior doctor had not had any training on prescribing anticipatory medication, which should be administered prior to death to help 
with pain relief and issues including nausea, and had to spend a long time trying to find the trust’s guidance.

Although they knew the theory 
from medical school, they did not know how it translated into clinical practice, 
but as the only doctor available 
they had no option but to deal with it.

When the patient did pass away, 
the doctor verified the death with 
no support, and was then expected 
to get straight back to the other 
patients who needed their care. No one debriefed them, and that was that.

Worryingly, they are not alone in their experience.

A new survey by the British Medical Association found that while more 
than nine out of 10 doctors feel that caring for a dying patient has an emotional toll on them, fewer than one in five felt that they were given sufficient support.

Most doctors can remember times when they struggled with their own grief when a patient they had been caring for died.

They often feel that somehow they’ve let the patient or their family down or spend time afterwards going over and over in their minds what extra they 
could have done.

Such feelings are all part of the 
normal bereavement process, 
something we regularly explain to our patients.

But it’s one thing to rationally talk about this process to others, it’s quite another to have to deal with those feelings yourself, and to have to deal 
with them on an all too frequent basis.

Being with a patient as they 
approach the end of life is one of 
the great privileges of being a doctor.

It puts everything else that we do into context.

However, even though as doctors we deal with death frequently, it doesn’t diminish the emotional impact that a patient dying can have.

This is why the BMA is calling for the use of support services to become normal practice across the NHS, to ensure doctors and nurses are able to cope emotionally and can provide the best possible care for patients and their relatives.

Death is a complex and emotive subject, making it incredibly important for doctors to be supported to discuss our thoughts and experiences surrounding dying.

At the end-of-life, patients and 
their families are at their most 
vulnerable and it is often when they need us most.

It is vital that doctors have the 
support, time and training 
necessary to get it right and provide 
as good a death as possible for those in their care.

Dr Richard Vautrey is a Leeds GP and deputy chair of the British Medical Association General Practitioners Committee.