HealthJune 23, 2020

Dealing with a bad prognosis: Coping strategies and self-care for doctors

By: Heidi Moawad, MD

Managing your feelings when a patient has a bad prognosis or outcome is an important part of self-care for doctors.

Many medical specialties primarily involve patient care with favorable results. This means that if you typically diagnose and treat patients who don't have life-threatening medical problems, you might spend most of your days providing good news.

But even doctors who treat patients with low morbidity and mortality occasionally identify serious diseases that are life-altering for patients and their families. You might be the one to discover that your patient has degenerative dementia or a life-threatening metabolic childhood illness.

When you aren't used to these situations, it can give you and your team a sense of helplessness and sadness. Managing your own feelings and helping your team cope can be a challenge, but it's crucial. Consider this advice for self-care for doctors dealing with poor prognoses.

Be grateful

The fact that you're sad about your patient's prognosis tells you something. It means that you've developed a strong doctor-patient relationship. You might know about their lives, their families and what they do in their time off. This is worth appreciating.

If you're in a specialty with inherently good outcomes, you often get to enjoy that nice feeling of giving your patients reassurance that their ailments will resolve. Or you write prescriptions or do procedures that tend to have good results. But feeling sad about your patient's struggle means that you're connecting beyond that, and this connection is something to be grateful for.

Talk with your staff if they feel sad about a patient's grim diagnosis. They might need to hear that their feelings stem from the fact that the work you all do together is more than just a job. You and your co-workers are an important part of your patient's community, and this isn't something to take for granted.

Be supportive

When you're used to giving patients good news, they might not be in dire need of compassion. But in the few circumstances when your patients need more hand-holding than usual, take some extra time to lend encouragement and follow up on how they're doing. Make sure they understand the next steps. Point them to support groups. And just let them vent or cry if they need to.

Knowing that you're staying in touch and doing what you can to streamline the medical process for your patient can be helpful for them, and it may be therapeutic for you as well. According to an article in the Journal of Prosthetics and Orthotics, practicing empathy improves provider satisfaction. So being a caring doctor is actually a component of self-care for doctors.

Learn about prevention

While some medical conditions aren't curable, they might be preventable. When you diagnose an incurable disease like a specific type of metastatic cancer, you might gain some peace of mind by learning about the updated research when it comes to prevention or early testing. You can then incorporate advice about prevention into your day-to-day work with your patients.

You might also consider speaking about prevention in your community or at the hospital where you work. You may decide to raise awareness for overlooked screening tests. And you can even advocate for better prevention and treatment by collaborating with a like-minded group of medical professionals. According to an article in Academic Medicine, physicians can influence health and science policy by working together.

When a bad prognosis isn't a typical aspect of your work, you may not be the specialist who treats these cases at the advanced stage. But you can still find a way to be part of the solution in the way that suits you best.

Take time for yourself

Finally, don't forget to take time for yourself. Supporting others is a great thing, but taking care of your own well-being is crucial, too. Think about which self-care coping strategies might be best for you. If you need to talk to someone, don't hesitate to reach out to a trusted friend, colleague, pastor or counselor to talk through your grief.

Consider finding a narrative about someone with the condition that your patient has in a book, documentary or movie. Realizing that you aren't alone in feeling the way you feel might help you cope.

You'll likely diagnose a number of patients who have heartbreaking stories throughout your career. If you made a point of selecting a specialty in which this isn't common, then you know what's right for your personality. Giving yourself a little extra TLC when things get stressful can help you move forward.

Heidi Moawad, MD
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