A doctor’s condolences

When a patient dies in the hospital, we go through a checklist that has become eerily mundane: Examine the patient to confirm the death. Notify the family, the senior doctor, the local organ bank, the admitting office, and (in some cases) the medical examiner. Fill out the report of death. Write a death note. Brace yourself against the emotional weight of the event and get on with your work. Nowhere in that process is a responsibility that should predate our medical training: the condolence letter.

I’d never written one for a patient until last week in the Intensive Care Unit when our team’s attending doctor brought up the idea. Instead of a fountain-penned, monogrammed note, ours was typed on hospital letterhead and signed with ballpoint pens. But it was a tribute all the same to what has become a dying tradition among doctors.

It’s a shame that the letter of condolence has gone the way of penicillin and the black leather medical bag. Part of the trouble, at least in the hospital, is that we may not know patients as well or for as long as we used to: hospital stays are now measured in days instead of weeks and residents work fewer, often odd, hours to comply with duty hour requirements. Working in teams, we often shift which doctor has primary responsibility for a given patient so niceties like letter-writing are more likely to get lost in the shuffle.

Beyond the logistical challenges, writing a condolence letter may feel like admitting fault or worse, defeat. The act makes us vulnerable to the heartbreak in our work so we let it slide and rest on the convenient but erroneous assumption that our patients’ families don’t care.

The science of writing a condolence letter is unlikely to be found in a medical textbook. But there is a (not-surprisingly small) body of literature on the topic that offers some guidance, suggesting that we include personal memories of the patient when possible and avoid superficialities and clichés. Regardless of its style, writing an honest letter may help a patient’s family find peace. It is also a chance for us to pause, acknowledge our limits as physicians, and gain closure. I’m adding it to my checklist.

Ishani is a journalist and a second-year resident in internal medicine/primary care at Massachusetts General Hospital.  She blogs at Short  White Coat.  Ishani’s blogs are reprinted on with the permission of the author.  Follow Ishani on Twitter @IshaniG.

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  1. Colleen Young (@VirtualHospice)

    Thank you for adding a letter of condolence to your checklist and for writing about it here. I will share this article widely.
    Community Manager
    Canadian Virtual Hospice

  2. Gil Grimes

    I have been writing these letters for some time. I did not do this early in my practice, and there felt like there was something missing. What I have found in the writing of this letter is that it helps provide closure for the physicians as well as the family. It allows me to acknowledge the suffering that I feel (arising no doubt from that latent sense that I did not get the job done) in a manner that is more healthy and helpful than recrimination and self doubt. It offers me a time during my day when, because of the nature of the letter, I will have to sit quietly for a moment and gather my thoughts about the events that have transpired. It asks me to reflect upon the life that was led, the purpose and role of the deceased, and my role in their life and death. It allows me the moment of sorrow for loss and gratitude for the time we are all given. It serves to remind me of the things that are important so that I do not treat them with casual familiarity as I acknowledge that they may be gone sooner than I realize. For the patients for whom I have developed a relationship, it allows me the chance to say a final thank you for being made a part of their lives with all the joy and sorrow that they hold, and reminds me again to be grateful for the patients I still have the good fortune to be able to greet on a daily basis.

  3. R. Cunningham

    We are but machines in the cog of the health care system. Condolences are wasted time, are inefficient. Your MBA executive administrator does not want you filling these out.

    • Andrew Holt

      I hope your negative comments only reflect an off moment. It all comes down to your personal choice. What do you want to stand for, what type of health care do we want to provide – clearly not what you have stated here.

  4. Patient Commando

    The compassionate letter is not to be underestimated. The following handwritten letter was posted under the title “This letter from my late mother’s doctor has changed my life” and can be viewed here. You will add to the current total of 2,192,602 views.
    Here’s a transcript:

    Dear Mr. ______________,

    I am the Emergency Medicine physician who treated your wife Mrs. __________ last Sunday in the Emergency Department at the New York Presbyterian Hospital. I learned only yesterday about her passing away and wanted to write to you to express my sadness. In my twenty years as a doctor in the Emergency Room, I have never written to a patient or family member, as our encounters are typically hurried and do not always allow for more personal interaction. However, in your case, I felt a special connection to your wife __________ who was so engaging and cheerful in spite of her illness and trouble breathing. I was also touched by the fact that you seemed to be a very loving couple. You were highly supportive of her, asking the right questions with calm, care and concern. From my experience as a physician, I find that the love and support of a spouse or a family member is the most soothing gift, bringing peace and serenity to those critically ill.

    I am sorry for your loss and I hope you can find comfort in the memory of your wife’s great spirit and of your loving bond. My heart felt condolences go out to you and your family.

  5. Andreas Laupacis

    Thanks for bringing this up, Ishani. I don’t know why I haven’t been writing these before. I have printed off the article from CHEST, and will start the next time I am on service. Andeas

  6. Sachin Pendharkar


    Thanks for writing about this. On a few occasions, I have posted online condolences for patients when the funeral home provided the service. It actually provided a sense of personal satisfaction that I completed my service to that patient and family. I am not sure why I don’t do something like this more often – thanks for the reminder!


  7. Donna Jensen

    How comforting to think a Doctor will take the time to acknowledge the value of a life!

    I’M 81 and would certainly feel honoured if my Doctor should write such a letter to my loved ones when my time comes.

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