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The toughest task for doctors treating coronavirus? Breaking bad news to families. | Expert Opinion

In the coming days, frontline providers and ICU doctors will be asked to shepherd the grief of an entire nation. An emergency medicine physician worries about the psychological toll on his fellow providers.

Matthew Trifan outside Jefferson Methodist Hospital.
Matthew Trifan outside Jefferson Methodist Hospital.Read moreTOM GRALISH / Staff Photographer

I am an emergency physician who, like many of my colleagues, is preparing for the grim reckoning of the novel coronavirus. The nation’s top infectious disease experts are predicting a death toll between 100,000 and 240,000 Americans. These dizzying mortality rates will change the way doctors interact with patients and their families. Soon, I will join a group of doctors tasked with breaking bad news on a scale unprecedented in our careers.

While we are no strangers to delivering bad news, even the most seasoned among us would balk at the magnitude of death ahead. We know from experience the tremendous toll each and every patient death notification takes on us. Most of us would gladly avoid serving as the messengers of death if possible.

Unfortunately, in the coming days, frontline providers and ICU doctors will be asked to shepherd the grief of an entire nation. I worry about the psychological toll of these encounters on my fellow providers. Our old defense mechanisms will likely prove a poor bulwark in the face of this tsunami of tragedy. We can no longer compartmentalize our emotions at work, pushing aside our pain for “later.” There will be no “later.” Without the hope of relief, this repetitive smothering of emotions can lead to apathy. As Albert Camus described in his 1947 novel, The Plague, “No doubt our love was still there, but quite simply it was unusable, heavy to carry, inert inside of us, sterile as crime or condemnation.”

Our emotional challenge is further compounded by our new time constraints. With this influx of critical patients, our resources will be stretched even thinner than before. Doctors will need to prioritize medical stabilization over our “softer” skills, such as bedside counseling. Perhaps the one thing that will suffer most is the family death notification. These conversations are often challenging and time-consuming, and we physicians simply might not have the luxury to offer families our undivided attention. This is not a prospect we relish, but it is the painful reality of disaster medicine.

Fortunately, there are steps we can take to address both the time constraints and emotional toll of this pandemic. If handled properly, we can provide resources and closure to families, without overburdening exhausted physicians.

First, we must design a system that shares the burden of bad news among many, rather than simply a few. For starters, a “medical liaison” should be designated to accompany doctors into family meetings. This person should be a knowledgeable professional, such as a trauma nurse or critical-care nurse, who can speak knowingly about the patient’s case. If the doctor is pulled away for another emergency, the liaison can take over the conversation. This will provide a “team” approach to delivering bad news, without neglecting families’ concerns or overwhelming one physician.

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Second, hospitals should hire more ancillary grief staff, including chaplains, spiritualists, and patient-care specialists. In addition to providing emotional support, these staff members can help survivors with logistical concerns, such as contacting funeral homes and returning patients’ belongings.

Third, hospitals should requisition additional “quiet rooms” for family grieving. Most emergency departments and ICUs have only one or two such spaces, often leaving families to gather in busy public spaces. By designating specific rooms for bereavement, hospitals can afford families with the privacy they deserve. Equally importantly, these rooms can ensure social distancing and infection control for families, including the elderly and vulnerable among them.

Finally, hospitals should offer medical providers training in disaster communication. This can include sessions with palliative-care experts, who can review the fundamentals of good communication. It can also include “simulation sessions” with professional actors, where providers can practice honing their speaking skills.

But make no mistake, even with these measures, the coming months will test the physical and empathetic limits of medicine. Doctors must remain vigilant for ways to anchor their humanity. Delivering bad news, if done properly, should be an opportunity to do just that. As one physician once told me, “When it comes to breaking bad news, it’s simple — be a human first and a doctor second.”

Matthew Trifan is a resident physician in emergency medicine at Thomas Jefferson University.