Blog: What Doctors Need to Learn About Death and Dying

The old man and the young woman sat across from one another stiffly perched on plastic chairs, staring down at the floor – doctor and patient. The tension in the room, exaggerated by the silence between them, was almost unbearable. Then the patient, stroking a trembling, emaciated hand across a hairless scalp, spoke haltingly, “Doctor, promise me I’m not going to die.”

According to a recent post in the New York Times by columnist Jane Brody, this type of interaction with a terminally ill patient creates occupational distress for many doctors who are not equipped emotionally to handle such a difficult situation. She states that doctors who are unable to cope with “their own feelings of frustration, failure and helplessness … may react with anger, abruptness and avoidance” toward their patients who are dying. When this occurs doctors may recommend futile treatments to patients at the end of life because they cannot connect with those patients on a human, suffering level and have nothing else to offer them.

The article touts mindfulness meditation, a practice recommended by palliative care specialist Dr. Michael Kearney, as a solution for discontent and disconnected doctors. I wholeheartedly agree that mindfulness meditation can be a very helpful practice for calming anxiety and learning to be present. However, I believe that this problem—doctors who find themselves unable to cope with perceived failure when a patient is dying—requires a deeper and more fundamental solution: doctors need a new understanding of death and therefore, life. 

These are the fundamental truths of death and dying that should be taught to every medical student from the first day of training:

1. Death is inevitable.

Every living thing on Earth will die. Death ultimately cannot be avoided or prevented, even though it can and should be forestalled when reasonably possible. The fact that every patient eventually dies creates a sense of hopelessness and futility for doctors if they pit themselves against death as an enemy—for that is a battle that can never be won. But those who recognize that the end of life is actually the final stage of human development can help their patients face their last days with dignity and make reasonable choices for their care and treatment.

2. Death is a mystery.

No matter how hard we try we simply cannot control or accurately predict when natural death will occur. In my hospice work I have seen many patients who lived far longer than expected, against all reasonable odds; and I have also seen patients who died much sooner than expected, from causes not related to their terminal illness. We have to accept this mysterious nature of death even while we work to circumvent it or prepare for its arrival.

3. Death makes life more precious.

When life is perceived against the dark backdrop of death, we can see how it shines and glistens for us, ever more precious because it is fleeting. This is the gift that our mortal nature provides us—an opportunity to cherish each moment simply for the fact that it will not last. 

4. Dying provides an opportunity for transformation.

In my work with hospice patients I have witnessed over and over the transformative power of love and forgiveness during the last days of life. When dying is respected as a natural part of life and time is allowed for the process to unfold, patients can turn their focus to matters of the heart and soul and find meaning in both life and death. But this does not happen when death is perceived as an enemy that must be resisted until the final breath is taken. Doctors can help their patients change focus by advising them with honesty when the time comes that pursuing further treatment is futile and will cause more harm than benefit.

 In my ideal world doctors would be educated in the wisdom of all aspects of health, including the decline of physical health that ends in death. Doctors would be the guides who help us make reasonable choices, who see beyond our fears, and who possess the compassion and tools to ease our suffering.  Doctors then would be the wisest members of our society, never deluded by the myth of immortality.

When a doctor such as this is asked by a patient, “How can I live, knowing I am going to die?’ the answer would be:

“You must turn your focus to those things that matter the most to you. Put your energy into living each and every moment fully rather than trying to escape death. Then when the time of your death arrives—and no one really knows when that time will be—you won’t feel bitter and deprived. You will be filled with the joy of a life of meaning—no matter how many years of life you have been given.”

Healing takes place, not when death is forestalled, but when life is embraced and affirmed in its entirety, from beginning to end. When doctors can fully understand the nature of death and dying they will become the true healers that are desperately needed in this world. 


Ep. 309 A Neurosurgeon’s Lessons on Love, Loss, and Compassion with Joseph Stern MD

Learn how his sister’s illness and death made this neurosurgeon a better doctor.

My guest Dr. Joseph Stern is a partner in the country’s largest neurosurgical group practice in Greensboro, North Carolina. While he has frequently worked with patients and families facing life-limiting illness, his experiences at the bedside of his sister during her nearly one-year ordeal with leukemia, changed everything for him. He shares how his own medical practice was affected by what he learned about the patient’s perspective on end-of-life care and how he envisions our medical system needs to shift in order to improve the care being offered to all patients. He is the author of Grief Connects Us: A Neurosurgeon’s Lessons on Love, Loss, and Compassion. Learn more about his work at his website:


Get the book here.

Listen here:

This episode includes:

  • The shock Dr. Stern experienced when viewing medical care through the eyes of a terminal patient
  • Why he wished his sister’s doctors had discussed her terminal prognosis with her
  • How to balance hope with reality when facing terminal illness
  • The additional lessons
  • he learned as healthcare proxy for his brother-in-law who suffered a brain aneurysm
  • The definition of “emotional agility” and why it should be taught to all medical students
  • How to improve empathy and communication skills for medical providers
  • Why palliative care should be started much earlier for all patients facing potential life-limiting illness
  • How Dr. Stern has changed his own approach to patients in light of what he has learned
  • How empathy and compassion can actually prevent burnout for medical providers rather than cause it

Links mentioned in this episode:

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End of Life, EOLPodcast, Spirituality

Ep. 237 Physician Burnout: Why Death Awareness Could Make a Difference

Learn how death-denial may contribute to physician burnout and how to change it.

In this solo episode I share my thoughts on the inner reasons why physicians may burn out and how increased death awareness could be a solution. Now more than ever we need death-informed education for all physicians, which would transform medical practice in general and especially end-of-life care.

Listen here:

Physician Burnout

This episode includes:

  • Survey showing that 44% of physicians report being burned out. largely due to external factors out of their control
  • Article by Dr. Keith Corl describes “moral injury” for physicians who are asked to practice in a way that violates their moral integrity
  • Multiple deeply-ingrained factors that arise from medical training and lead to lack of satisfaction in medical practice
  • 4 principles all med students should be taught:
    • Death is inevitable and not a failure
    • Death is a mystery we cannot control
    • Death makes life more precious
    • Dying is an opportunity for transformation
  • Doctors need to find balance between holding onto life and letting go when the time is right
  • Also need to learn to grieve over patient deaths in a positive way

Links mentioned in this episode:

If you enjoy this content please share it with others and consider leaving a review on iTunes! Thanks again to all supporters on my page at Patreon.com/eolu, especially my newest Patron  Donna Peizer. Your contributions make all the difference!