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.