The document discusses the challenges doctors face regarding death and dying. It notes that doctors are expected to save patients and view death as a failure. While training prepares doctors to make logical decisions in crises, frequent encounters with death can trigger despair, shock, or emotional numbness. Witnessing memorable patient deaths evokes vivid memories for doctors. The document recommends that death be discussed openly, that feelings are normal and healthy, and that peer support groups provide validation for doctors to process deaths. Training in discussing end of life options with families could help doctors address this challenging aspect of their work.

1. Doctor & Death
DR BIJU SUNNY
SR CONSULTANT PSYCHIATRIST

2. The legend of the healer
 Man has always wanted to be saved…from war, from adversities, from
evil, from pestilences & plagues & from the uncertainty of his end.
 Legends are born to bring hope.
The all-knowing, wise physician who can snatch the sick, from the jaws
of death. A man from amongst them, but above them all, perfect in
behaviour, thought & possessing the ability to heal
The healer also carries the legend in his heart. He is the physician today

3. Burden of the physician
 Physicians are expected to be invulnerable. Emotional weakness is a
sign that you are not a “real “ physician >>> stress is
unacknowledged & surfaces as “Burn out syndrome”
 Burn-out - predominantly irritable, crabby mood, poor sense of
personal fulfilment, looking forward to minimal patient interaction,
lack of enthusiasm, exhaustion, questioning one’s decision about
choosing the profession
 Burn-out leads to addictions, drug abuse for insomnia, increased risk
of metabolic syndrome, emotional & behavioural problems, marital
disharmony & suicides

4. Let us talk about death
 Medicine is focussed on treatment & cure. A doctor is supposed to
keep a patient alive, somehow. Dying is not part of our syllabus. Death
& dying are parts they never told us about!
 Death is like a statement of failure to the physician.
 Medicine is dealing with improving chances of recovery. Death would
appear to be the last thing training will be provided for

5. Physician’s response to crisis
 Training is provided for developing an ACTION mode during a crisis. In
this mode, there is a functional disconnect between emotions & actions.
Decisions are guided by training, gut feeling, logical thinking etc..
without emotional contamination.
 Despite this training we encounter death frequently. This can trigger
despair or shock sometimes
 We counter this with morbid sense of humour or feel emotionally numb
for a day or 2, if it cannot be processed adequately

6. Emotional response to Death
 Feeling of responsibility & the keen awareness of what the family expects
out of us
 ” I am used to this”…memorable patient deaths evoke vivid, emotionally
rich memories, often many years back.
 Early years of training sees frequent self doubt about worth, competency
etc . Tendency to look back to see if everything was adequately done
 Shared human experiences of uncertainty, loss, courage & sacrifice

7. What can be done?
 Understand that death needs to be seen differently, it has its place in the
doctor’s life & we need to learn about it, talk about it. To know that feeling
emotions is healthy. To know the difference between the 2 extremes of being
emotional & being always on the “ACTION” mode
 We all need validation about how we are. Avenues of discussion with peers &
seniors goes a long way to foster healthy discussion. These must be different
from mortality meetings…the focus here being to give a patient listening &
support
 Encourage engaging with the family about death, get a senior nursing staff
would be helpful

8. What can be done?
 Training for a pre-emptive discussion with family
& going over possible options outcomes etc
 Clinical obituary