Authors
- Vinita Rane1,
- Vinita Rane2,
- Akshay Ilango2,
- Anjali Dhulia2,
- Rosemary McKemmish2,
- Leeroy William2,
- Leeroy William3
- University of Melbourne1,
- Monash Health2,
- Monash University3
2018
Excerpt
Introduction
All doctors are required to care for dying patients and their families at some stage in their careers. The delivery of end-of-life care is critical in respecting the end of a life, but also to the bereavement of those they leave behind. However, it is well recognized that these emotive events may also exert a heavy toll on staff involved in the care. Furthermore, there is a paucity of literature on doctors’ emotional experiences in caring for these patients. What does exist is largely anecdotal and describes sadness, guilt and stress. These are all risk factors for professional burnout. As a result, medical staff may feel ill-prepared to deal with death and dying, especially junior doctors with less clinical experience who may question their own competence. Junior doctors may also hesitate to discuss their uncertainties with their supervisors, feeling that it is not acceptable to do so.
We describe a novel pilot program that aimed to assist junior medical staff to recognize and manage difficult emotions such as grief, guilt and anxiety in a small group setting, facilitated by a palliative care physician and a psychiatrist.
Methods
From September 2017 to November 2017 we ran three pilot sessions open to any junior doctor employed by Monash Health, a large tertiary teaching hospital in the south-eastern suburbs of Melbourne, Victoria. The participants self-nominated their interest via the Chief Medical Resident and were asked to have a specific case in mind that they wished to discuss. Each session was held in the evening away from the acute ward environment in the Quiet Room in the palliative care unit. Each ran for two hours and catering was provided. Participants were limited to six per session. The sessions were co-facilitated by a palliative care physician and a psychiatrist. In addition, the hospital’s health and wellbeing officer attended as an observer and to provide follow up if anyone was especially distressed. The participants completed an evaluation at the end of the session.
Results
Overall, twelve JMO participated and completed an evaluation. There was an even mix of interns and registrars. The evaluations were extremely positive, with all of the participants stating that they felt they gained valuable knowledge. For example, they recognised a benefit to future patient interactions, confidence in managing dying patients, and insights to strengthen collegial teamwork. Junior participants especially also found it reassuring that their emotional response was normalized by senior clinicians, and this helped them process their own experience. Crucially, all of the participants stated they would recommend Lessons from the Dying to other colleagues and 10/12 (83%) stated they would attend another session. Participants found having experienced clinicians from different specialties who were also not involved in their supervision or training particularly helpful.
Discussion
This innovative intervention, involving both a psychiatrist and palliative care physician as facilliators, is the first of its kind to be described. It was evaluated very positively by the participants and the vast majority found the issues discussed both relevant to their day-to-day work, as well as having an impact on changing their practice in the future. It provides a safe, non-judgmental environment for junior doctors to reflect on their practice and to improve communication skills. Ongoing work needs to be done to continue to support the sessions to enable more participants to attend.
All doctors are required to care for dying patients and their families at some stage in their careers. The delivery of end-of-life care is critical in respecting the end of a life, but also to the bereavement of those they leave behind. However, it is well recognized that these emotive events may also exert a heavy toll on staff involved in the care. Furthermore, there is a paucity of literature on doctors’ emotional experiences in caring for these patients. What does exist is largely anecdotal and describes sadness, guilt and stress. These are all risk factors for professional burnout. As a result, medical staff may feel ill-prepared to deal with death and dying, especially junior doctors with less clinical experience who may question their own competence. Junior doctors may also hesitate to discuss their uncertainties with their supervisors, feeling that it is not acceptable to do so.
We describe a novel pilot program that aimed to assist junior medical staff to recognize and manage difficult emotions such as grief, guilt and anxiety in a small group setting, facilitated by a palliative care physician and a psychiatrist.
Methods
From September 2017 to November 2017 we ran three pilot sessions open to any junior doctor employed by Monash Health, a large tertiary teaching hospital in the south-eastern suburbs of Melbourne, Victoria. The participants self-nominated their interest via the Chief Medical Resident and were asked to have a specific case in mind that they wished to discuss. Each session was held in the evening away from the acute ward environment in the Quiet Room in the palliative care unit. Each ran for two hours and catering was provided. Participants were limited to six per session. The sessions were co-facilitated by a palliative care physician and a psychiatrist. In addition, the hospital’s health and wellbeing officer attended as an observer and to provide follow up if anyone was especially distressed. The participants completed an evaluation at the end of the session.
Results
Overall, twelve JMO participated and completed an evaluation. There was an even mix of interns and registrars. The evaluations were extremely positive, with all of the participants stating that they felt they gained valuable knowledge. For example, they recognised a benefit to future patient interactions, confidence in managing dying patients, and insights to strengthen collegial teamwork. Junior participants especially also found it reassuring that their emotional response was normalized by senior clinicians, and this helped them process their own experience. Crucially, all of the participants stated they would recommend Lessons from the Dying to other colleagues and 10/12 (83%) stated they would attend another session. Participants found having experienced clinicians from different specialties who were also not involved in their supervision or training particularly helpful.
Discussion
This innovative intervention, involving both a psychiatrist and palliative care physician as facilliators, is the first of its kind to be described. It was evaluated very positively by the participants and the vast majority found the issues discussed both relevant to their day-to-day work, as well as having an impact on changing their practice in the future. It provides a safe, non-judgmental environment for junior doctors to reflect on their practice and to improve communication skills. Ongoing work needs to be done to continue to support the sessions to enable more participants to attend.