April 20, 2017

Why one doctor attends his patients' funerals

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on Sept. 16, 2019.

    In a recent commentary for WBUR's "CommonHealth," palliative and family care physician John Loughnane reflects on why he has attended his patients' funerals over the years—a decision he originally thought of as a "nice gesture," but one he quickly came to realize gave him far more than he could hope to offer.

    7 tools to implement a holistic patient experience strategy

    The emotional toll of a patient's death

    Greg Crawford—associate professor of palliative medicine at the University of Adelaide in Australia, who co-wrote a study on attending patients' funerals—said a patient's death can be "a very emotional and isolating experience for physicians," something they might perceive as a failure. According to Crawford, attending a patient's funeral can have a twofold benefit: offering comfort to the patient's family and also helping a physician come to terms with his or her own emotions. 

    And Crawford's research showed the practice may be more common than one would think: 57 percent of respondents—all of whom were Australian doctors—said they had attended at least one patient's funeral. But attendance varied sharply by specialty, the study found, with 71 percent of general practitioners reporting having attended a patient funeral compared with 22 percent of intensive care specialists.

    A personal reflection

    In his commentary, Loughnane, chief of innovation at Commonwealth Care Alliance, explained that he initially went to funerals, wakes, and other celebrations of deceased patients' lives as a way to honor a "deep connection" between himself, and the deceased patient. But he "quickly learned … that being present at these memorials gave [him] much more than [he] could ever reciprocate."

    For instance, in one case, he was invited by a family to say a few words. The ceremony was mostly in Haitian Creole and he "didn't understand a word," but the bond among those who attended went "beyond spoken language," Loughnane writes.

    And in another case, involving a patient named Sandra, Loughnane says he attended to "bear witness to her courage." He added, "Her courage guided me and her care team to honor her wishes and extubate her, rather than confine her to a chronic respirator in a facility for the rest of her life."

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    Loughnane has also attended funerals for more somber reasons, such as to say sorry to a patient named Robert. He explained, "I went to say sorry—sorry that we couldn't do a better job, and that we would have made different decisions in hindsight. I went to acknowledge that despite our best efforts and the best medical care we could provide, it was not enough. It was a confession of humility given to his family and loved ones, and they gave generous absolution, drawing from a core humanity we shared."

    'Safe passage through the tombstones'

    Loughnane had an early lesson about the emotional burden of caring for patients who pass away. During medical school, Loughnane's senior resident, Anton—a physician who had practiced medicine in Russia for more than 30 years before coming to America—often said that "every physician has [his or her] own graveyard, and each night before sleep he or she walks through the tombstones revisiting these patients," Loughnane writes.

    "This bit of wisdom was deeply disturbing to me as a medical student," Loughnane continues. "But after practicing for nearly 20 years, I find comfort in his words." He explains, "The practice of medicine, especially for those of us who care for the actively dying, is full of graveyards that we revisit. To do so is only human."

    In turn, Loughnane says the time he spends attending the funerals of his patients helps him as he walks "through [his] own graveyard of patients," allowing him "to acknowledge the loss, and to move on and try to help others the best I can." He concludes, "These funerals are a gift of shared human experience that creates a safe passage through the tombstones" (Loughnane, "CommonHealth," WBUR, 4/10; Finnegan, FierceHealthcare, 4/17; Finnegan, FierceHealthcare, 9/23/16).

    7 tools to implement a holistic patient experience strategy

    Even with renewed investment in patient satisfaction, many institutions are struggling to improve, often because they define the ambition too narrowly or pursue a campaign-style approach.

    To achieve lasting improvements in patient experience scores, clinicians must re-scope their goals to address patients' overall experience, rather than discrete HCAHPS measures.

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