Doctors Don’t Grieve, Residents Don’t Sleep
Many doctors appear to believe they aren’t human — and don’t have normal human needs like the rest of us. At least according to two new studies recently released.
In an opinion piece published in Sunday’s New York Times, researcher Leeat Granek shares the results of two studies that suggest to her that, “Not only do doctors experience grief, but the professional taboo on the emotion also has negative consequences for the doctors themselves, as well as for the quality of care they provide.”
A different study released by the JAMA journal, Archives of Surgery, last week found that residents don’t get as much sleep as ordinary professionals get — which directly impacts their ability to concentrate and be mentally attentive.
Combined, these studies add to the picture that’s been painted for years by research — that doctors believe they are somehow “super human” and beyond the reach of normal human needs, for both their body and their mind. It’s a disturbing picture, and one that the medical education establishment needs to remedy sooner rather than later.
In the op-ed piece, researcher Granek summarizes the results of her study:
We recruited and interviewed 20 oncologists who varied in age, sex and ethnicity and had a wide range of experience in the field — from a year and a half in practice in the case of oncology fellows to more than 30 years in the case of senior oncologists. Using a qualitative empirical method known as grounded theory, we analyzed the data by systematically coding each interview transcript line by line for themes and then comparing the findings from each interview across all interviews to see which themes stood out most robustly.
We found that oncologists struggled to manage their feelings of grief with the detachment they felt was necessary to do their job. More than half of our participants reported feelings of failure, self-doubt, sadness and powerlessness as part of their grief experience, and a third talked about feelings of guilt, loss of sleep and crying.
While I agree that there very well may be a “professional taboo” on professionals expressing grief — and this is true of virtually all health and mental health professionals — I’d argue that, in the U.S. anyway, expression of grief isn’t exactly something most people do well to begin with.
Visit anyone’s viewing for a snapshot of how Americans handle their grief:
some people cry, others nod in awkward silence, still others make small talk. Very few people feel comfortable in their grief, and fewer still in expressing it.
So maybe it’s not a surprise that doctors don’t do it very well at all, either.
But what makes it different for doctors is that their lack of skills in dealing with their grief could very well impact their job and decision-making — negatively impacting other people’s lives too:
Even more distressing, half our participants reported that their discomfort with their grief over patient loss could affect their treatment decisions with subsequent patients — leading them, for instance, to provide more aggressive chemotherapy, to put a patient in a clinical trial, or to recommend further surgery when palliative care might be a better option. […]
Unease with losing patients also affected the doctors’ ability to communicate about end-of-life issues with patients and their families. Half of our participants said they distanced themselves and withdrew from patients as the patients got closer to dying.
Doctors (and therapists, too!) have a responsibility to acknowledge and appropriately cope with their own grief reactions. And heck, if they don’t have the skills to do so, they should learn them.
In the second study, 27 orthopedic surgery residents wore a wristwatch-type of measurement to gauge how often they slept. The average amount of daily sleep for the residents was just over 5 hours, with individual amounts ranging from 2.8 hours to 7.2 hours.
This lack of sleep is not good for their mental attention span:
The authors found that, overall, residents were functioning at less than 80 percent mental effectiveness due to fatigue during a mean of 48 percent of their time awake. Residents were also functioning at less than 70 percent mental effectiveness due to fatigue during a mean of 27 percent of their time awake.
Most docs are good people trying to do good in this world. But the more they act like they aren’t human and don’t have the same human needs and feelings the rest of us do, the more harm they bring to their patients.
Read the NY Times article: When Doctors Grieve
Grohol, J. (2012). Doctors Don’t Grieve, Residents Don’t Sleep. Psych Central. Retrieved on May 22, 2015, from http://psychcentral.com/blog/archives/2012/05/29/doctors-dont-grieve-residents-dont-sleep/