Systematic review of the impact of patient death on surgeons

Abstract

Background: The death of a patient is experienced at some time by most surgeons. The aim of this review was to use existing literature to establish how surgeons have dealt with the death of patients.Methods: A systematic review of the medical literature was performed. MEDLINE/PubMed, Ovid, Web of Science, Embase, and Google Scholar were searched for qualitative and quantitative studies on surgeon reactions when facing death or a dying patient. This systematic review was performed following the recommendations of the Cochrane collaboration and reported following the PRISMA guidelines. Individual and interview-based opinions were summarized and synthesized.Results: An initial search found 652 articles. After exclusion of articles that did not satisfy the inclusion criteria, 20 articles remained and seven were included. Two of these articles were personal opinion of the author and five were interviews or surveys. The main findings were that facing death routinely induces a strong psychological burden and that surgeons are more at risk than the general population to develop psychological morbidity.Conclusion: Although it is a frequent and emotional subject in the surgical world, the impact of patient death on surgeons is not abundantly studied in the literature. Dealing with patient death or taking care of a dying patient might have long-lasting psychological impact on surgeons.

Learning from regret

“…The death of a patient often places a heavy psychological burden on surgeons. Reducing the likelihood of regret is an important outcome of surgical decision‐making and may help to alleviate the psychological impact.…”

“…Surgical decision‐making frequently involves complexity, uncertainty, time pressure and limited information. If a patient dies, surgeons may experience emotional reactions, including disappointment, sadness, rumination, perceptions of missed opportunities and possibly regret. Regret may be an unavoidable part of clinical practice and differs from the response to medical error because, even following the best decisions and actions, adverse outcomes occur.…”

Tweets of the month

“…According to a Twitter poll referencing the above reported articles, fewer than half of the respondents were familiar with this concept. As suggested during the August #BJSConnect tweetchat with Professor N. Demartines, co‐author of the systematic review, personal introspection and adequate support are both needed to accept the death of a patient.…”

“…The October issue featured a systematic review by Joilat et al 3 , which explored the effects of patient death on surgeons, and was accompanied by a leading article 4 . The article highlighted how surgeons need to be aware that death is part of their profession, and @terrysimpson responded that 'every surgeon has his/her own graveyard'.…”

This month on Twitter

“…The BJS tweetchat with Nicolas Demartines on the impact of patient death on surgeons engaged 100 participants, who posted 504 tweets, generating an estimated 4·5 million impressions for the #BJSConnect hashtag (data from http://Symplur.com).…”