It wasn’t long into my hospital chaplaincy career that I figured out that physicians do not like notifying a family that their patient loved-one has died. I’m mainly referring to a patient who has come into the Emergency Department because of a trauma like a motor vehicle crash or a cardiac arrest.
Typically the family of these patients are led to a small private waiting room while the physician and nurses do all they can to save the life of their loved-one. If the patient is stabilized the physician will go to the room and update the family on their loved-one’s condition. If the patient does not survive the trauma the physician will go to the room and inform the family that their loved-one has died.
As a chaplain I am usually accompanying the physician to inform the family that their loved-one did not survive. The best way to break this bad news is to simply state that although all was done to save their loved-one, they didn’t make it and they died. The quicker a physician states their condolences and clearly communicates that the person has died, the better it is for all involved.
When I was new to hospital chaplaincy, it used to confuse me why some physicians seemed to avoid telling the family their loved-one died. I’ve watched physicians avoid getting to the point by asking the family to explain the circumstances before their loved-one was brought in by ambulance. Unfortunately, this kind of delay only creates a false hope in the minds of the family and greater shock once they learn of the death.
However, I learned something about physicians and why death notifications are difficult for them. It eventually occurred to me that physicians bear a sense of professional failure when a patient dies, even though the life of that patient is ultimately not in their hands. Hebrews 9:27 states that “it is appointed unto men once to die” and the truth is that God has the final say in a patient’s recovery. Physicians not only deal with the difficulty of felt failure, but they must practice under the weight of a litigious society. Sadly, some families refuse to accept mortality’s inevitability and immediately assume someone is to blame through a lawsuit.
In recent years I have come to have a great deal of empathy for physicians when it comes to their role in death notifications, especially in the hospital emergency department where the family doesn’t see the effort and energy extended by the physician and an interdisciplinary medical team for their loved-one.
So I have developed a simple acronym for physicians to make death notifications easier and I want to introduce it here. I am suggesting physicians keep the letters “IED” in mind when they make a death notification for a family.
I — Identify yourself as the physician who was caring for their loved-one and what you have done since they arrived in the ED. By explaining a little about how you cared for the patient, it will also naturally lead to informing them of the death.
E — Express that their loved-one has died. Give your condolences and know that sometimes saying it in two different ways helps the family understand, like “I’m sorry he didn’t make it, he died.” You can also ask if they have any questions.
D — Designate for the family who will guide them through the next steps of taking them to see their loved-one and getting information. The person to designate would be either the RN or the Chaplain and that will allow you a clean exit from the room
You may have already thought about it but this acronym IED may remind you of the acronym from middle eastern war zones for Improvised Explosive Devices. It may feel like your death notification may leave a great deal of impact on the family in a similar way the Improvised Explosive Devices did on our soldiers and their Humvees, and it does. This is why chaplains remain with the family after the physician leaves following the death notification.
Generally speaking, when it comes to a physician’s death notification to the family, it is important to get straight to the point and inform the family that their loved-one has died as soon as possible. The longer a physician sits with the family and delays telling them the patient has died, the more the family gets their hopes up that their loved-one is okay and still alive. That delay means the family’s grief outburst will only be greater than it would if the news was shared sooner.
If you are a physician who doesn’t particularly like death notifications, please try using this IED acronym as a guide to help you the next time you’re called upon to inform a family.
Let me know what you think about this, too. Contact me.