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By Lisa Esposito HealthDay Reporter WEDNESDAY, May 23 (HealthDay News) — Some cancer doctors maybuild up emotional walls — distancing themselves from thepatients they can't save — to avoid grief, sadness andeven despair, new research shows. In a profession where death and dying "are part and parcel ofthe work," study author Leeat Granek said grieving is mixedwith "feelings of self-doubt, failure and powerlessness thatcome from the idea that doctors are responsible for theirpatients' lives and for making their treatmentdecisions." Twenty oncologists at three adult cancer centers in Ontariodescribed how they dealt — or didn't deal — withgrief, and its effect on their professional practice and personallives. The report was published online May 21 in the Archives of Internal Medicine . "The issue with doing oncology is that you walk a very fineline," one doctor said. "If you get too involved withyour patients you can't function because it's too muchemotional load to bear, and if you get too distant from yourpatients then I don't think you're being a very goodphysician, because people pick up on that." "Sometimes the grief comes home with the oncologist,"said Granek, a postdoctoral fellow at the Hospital for SickChildren in Toronto. Although some doctors"compartmentalized" in order to function, others haddifficulty sleeping or enjoying time with their family. But there were positive reactions, too. Some physicians found theyhad a better perspective on life from frequent exposure to patientloss. And some felt motivated to give better care. The study referred to the physician's burden of"holding hard knowledge." "Sometimes I'll take a chart and I'll look at theimaging, and everything's worse and the numbers areworse," a doctor said, "and I have to drag myself intothe patient's room and figure out what can I offer themthat's hopeful and positive. It's tough." Several oncologists said they cried on the way home in their cars.But feelings were kept private or submerged. "Losing any patient is difficult," said Dr. LenLichtenfeld, deputy chief medical officer at the American CancerSociety. "But there is no time to grieve. You have a momentor two to reflect and then you're on to the next patient whoneeds your help." Granek said that "even just acknowledging that grief overpatient loss exists and that it's part of the professionwould be healthier than what is happening now. There is noacknowledgement at all, and there's denial." Other patients might be affected in the aftermath of a loss, somerespondents suggested. "Maybe I got that case after someone had just died and I wasin a more aggressive mode," one physician said. "Or,maybe I undertreated someone because I just saw a patient withterrible toxicity." Doctors talked about being distracted, less focused. When patientswere dying, some physically distanced themselves, avoiding thehospital and bedside. Patients and family members can sense this distance. Lichtenfeld told of a bereaved husband whoconfided in him after his wife had died of breast cancer. Caring professionals "would spend time with him, talk to him,look at him, hold his hand, ask how he was feeling,"Lichtenfeld said. But others "would not engage in thosebehaviors — they would look the other way, they would notlook him in the eye, they would rely on ‘the data, the data,the data,'" in conversations. "If you're troubled about the way the physician ormembers of that team are relating to you," Lichtenfeldrecommended "bringing it up as part of theconversation." An accompanying journal commentary described how one institution isdealing with the situation. Since 2008, the University of RochesterMedical Center in Rochester, N.Y. has held staff support meetings— mandatory for oncology fellows — where practitionersare encouraged to discuss their experiences with patient loss andgrief. "Feelings of frustration, anger, loss, isolation andinsecurity often emerge in a setting that is nonjudgmental andsupportive," wrote oncologists Dr. Michelle Shayne and Dr.Timothy Quill. "At the end of each one-hour session, a momentof silence is observed in remembrance of patients who have recentlydied, and the opportunity to remember and honor a patient who hasdied by saying his or her first name is offered." Oncologists "are working very hard and doing this phenomenaljob with very large numbers of patients," Granek said,"and they could use a little bit of support with thispiece." More information Visit Healthguide.org to learn about anticipatory grieving . SOURCES: Leeat Granek, Ph.D., postdoctoral fellow, Hospital forSick Children, Toronto; Len Lichtenfeld, M.D., deputy chief medicalofficer, American Cancer Society, Atlanta; May 21, 2012, Archives of Internal Medicine , online Last Updated: May 23, 2012 Copyright 2012 HealthDay. All rights reserved. We are high quality suppliers, our products such as Industrial Polyester Thread Manufacturer , China Polyester Dyed Yarn for oversee buyer. To know more, please visits White Sewing Thread.
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