BackgroundA growing body of research indicates that physicians suffer high levels of stress, depression and burnout. Related literature has found that physician stress can negatively impact patient care. This study builds upon previous research that found some dying patients experienced ‘iatrogenic suffering’ caused by the way physicians communicated with them regarding terminal diagnoses and palliative treatment. The goal of this research was to explore physicians’ experiences of dealing with patient death in order to understand how such experiences affect them and their communication with patients.MethodsThis study used qualitative methods to conduct and analyse 10 individual, semistructured interviews with senior physicians from several specialty areas at a large, tertiary care hospital. The resulting themes were validated using member checks and expert review.ResultsThis article presents five essential themes that provide a concise description of the lived experience of patient death for these physicians. Interpretation: These themes indicate that physicians can experience very strong and lasting emotional reactions to some patient deaths, and also that patient death can elicit intense experiences related to professional responsibility and competence. A key finding is the description of a complex process of managing the balance between personal and professional reactions in the face of patient death. The implication is that difficulties negotiating this balance may lead to unintended lapses in compassion and suboptimal outcomes in patient care.

We propose that a tool such as CENTRE be considered for a range of group situations, including clinical family meetings, teaching, professional teams and Balint-type groups. We are currently using this approach in clinical, academic and other professional environments. Findings from a survey of groups where CENTRE was used suggested that participants find the process useful. We believe a tool such as CENTRE can be used to help address relational issues, promote psychological safety, inclusion and trust among members, and reduce the risk of undeclared expectations and assumptions from dictating how groups function. Assumption-based and implicit agreements can engender friction because unspoken or unclear agreements are not easily addressed.

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