The COVID-19 pandemic held a mirror up to the world in various ways, asking u together in a time of collective trauma. The pandemic also shined a deeper light on how people, and healthcare workers (HCWs) specifically, experience and manage grief and loss. 

For HCWs—even more so for those who are new to the field—personal and professional grief management strategies are key. While COVID-19 got people talking about grief more openly, the Journal of Pain and Symptom Management says that grief has always been problematic for HCWs: “Despite the inevitable losses of serious illness and the reality of human mortality, grief has long lived uneasily in the practice of clinicians. This may be especially true for physicians, given that discipline's tendency to see illness as an enemy to be battled against and death as a professional failure,” the authors write.

Rabow MW, Huang CHS, White-Hammond GE, Tucker RO. Witnesses and victims both: healthcare workers and grief in the time of covid-19. J Pain Symptom Manage. 2021;62(3):647-656.

How physicians manage grief—specifically in their personal lives.

A recent Journal of the American Medical Association (JAMA) essay entitled “Lying to My Mom,” by Chris Feudtner, MD, PhD, describes his older mother’s hospitalization due to a fall. At the hospital, the staff notified Dr. Feudtner that his mother had a possibly cancerous liver mass—discovered through happenstance. In the essay, Dr. Feudtner, a medical ethicist, details how and why he chose not to tell his mother, instead letting her live out her days in peace. While the piece is about the ethics of the choice that Dr. Feudtner made, it’s also about the way HCWs handle grief in their own lives.

Feudtner C. Lying to my mom. JAMA. Published online September 20, 2023.

Dr. Feudtner tells MDLinx that the essay bridges the gap between practice and the personal—and that writing about it openly is what helped him cope with loss.

“The response that I’ve already received from readers, with more emails and comments than I had ever imagined, suggests that this is a very important set of issues and tradeoffs for us to talk about—privately and publicly,” Dr. Feudtner says. “In a classroom setting or general discussion divorced from the difficult realities of trying one’s best to take care of a loved one, these rules seem to offer bright and clear lines; in lived practice, there is much more gray.”

Emergency care physician Katrina Mattingly, MD says that training as a physician means seeing death regularly while at work can carry over into her own personal grief: “It’s hard to take off the physician hat. By nature, you start asking the care team what is going on, what has been tried, and what else can be done,” she says. “Once impending death becomes inevitable, the hard part is explaining to relatives that the time is here, and this is the final outcome. They don’t understand many times, but they trust you.” 

Dr. Mattingly goes on to say that when she grieves with family, she moves beyond being an MD and simply “feels human again.”

Dale G. Larson, PhD, Professor of Counseling Psychology at Santa Clara University, says it’s important to do deep, honest check-ins with the self when experiencing personal grief. “In addition to all the resilience-enhancing practices I keep going to (like exercise, social connections, [and] finding meaning in my work and life),” Larson says, “I slow down, do some deep inner googling, process everything that comes up, and honor the other and the meaning of our relationship.”

Insights and tips on managing grief for healthcare workers

Iris Waichler, MSW, LCSW, tells MDLinx that while in the workplace, HCWs may be able to better compartmentalize their emotions after a patient dies; it can be trickier when it’s personal. “Compartmentalization helps doctors perform the necessary medical care they need to assist their patients…[but] when a doctor experiences the death of a loved one, they must cope with the universal emotions associated with grief,” Waichler says—and this means going through potential feelings of helplessness, frustration, and depression. 

To compound the issue, she says, “There may be unrealistic expectations placed on doctors—by themselves or others—in terms of them having a greater ability to cope with death since it is something they are more familiar with in their professional lives,” she continues. Friends and family members may even seek additional information about the person dying from an MD, which can be yet another source of stress, she adds. 

She suggests talking openly to a friend, spiritual guide, rusted colleague, or mental health professional who specializes in grief. More so, she says, HCWs may want to consider taking time away from work, “since practicing medicine can be a very demanding and intense profession. This is especially true if the doctor works with patients with life-threatening diagnosis.”. 

Lastly, it’s important that better training and support is offered to HCWs. A review of grief support training published by PLoS One found that, “grief remains part of the ‘hidden curriculum’ in medical education,” leading to physicians adopting the “‘soldier on and deal with it’” approach.

Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLoS One. 2019;14(11):e0224325.

The authors say that “physicians’ personal or professional experiences with grief can result in burnout and depersonalized care,” and that “providing physicians with the knowledge and skills to offer grief support to patients, bereaved caregivers and colleagues at critical moments cannot be understated.”