'Memorable patient deaths': reactions of hospital doctors and their need for support.

摘要

OBJECTIVES: To investigate the reactions experienced by hospital doctors following a recent memorable patient death, defined as a patient death that had occurred in the previous few months that the doctor recollected for any particular reason, the coping strategies employed to deal with these reactions, the impact of training, and the need for support in future situations. METHODS: We carried out a descriptive survey in 2 teaching hospitals and 1 district general hospital in West Yorkshire, UK. Subjects comprised 188 hospital doctors of all grades (from pre-registration house officer to consultant) who were attending 12 educational lunchtime meetings. Main outcome measures included the associations between the intensity of emotional and physical reactions measured using a categorical rating scale, and exposure to previous training, gender, seniority and medical specialty. RESULTS: Reactions of moderate to severe intensity to a patient death were experienced by 5.0-17.5% of doctors, regardless of gender, seniority or medical specialty. Perceived need for both training and increased support from team members was significantly associated with more intense reactions. Common coping strategies included talking, spending time alone and exercise. There was no relationship between respondents' exposure to previous training and the intensity of emotional or physical responses. CONCLUSIONS: Many doctors perceive that they deal with death well. In a minority of doctors, more supportive approaches are necessary that may include both proactive and reactive measures. Examples include raising awareness of support services and establishing formal training programmes, and increasing awareness among senior clinicians of the need to support some team members after a patient's death, which may include ensuring that timely access to a counsellor is provided.