Division of Emergency Medicine, University of Washington, Seattle, WA, USA.
Acad Emerg Med. 2011 Mar;18(3):255-60. doi: 10.1111/j.1553-2712.2011.01004.x.
There is a growing awareness of the effects of patient death on physician well-being, and the importance of cultural and educational changes to improve coping mechanisms. The objective of this study was to explore both the effects of patient death on academic emergency physicians (EPs) and the coping mechanisms they use to deal with these events.
Faculty at a convenience sample of four emergency medicine (EM) residency programs were questioned about their responses to patient death in a 15-question on-line survey. Descriptive analysis of the data was performed. Independent variables were analyzed for differences in complaints of physical symptoms or consideration of important life changes after patient death.
Of 207 EPs surveyed, 145 (70%) responded. Patient death was experienced frequently, with 95 (66%) witnessing a death at least every month. No training on coping with patient death had occurred for 35 (24%); 93 (64%) had less than 6 hours of training. The most common coping mechanisms included talking with colleagues (113; 78%) or friends and family (100; 69%), as well as simply continuing to work (89; 61%). Postdeath debriefing occurred rarely or never for 93 (64%) of respondents. Most EPs had experienced physical responses to patient death, the most common being insomnia (54; 37%) and fatigue (21; 14%). Common emotional responses included sadness (112; 70%) and disappointment (55; 38%). No significant differences in response rates for physical symptoms or consideration of life changes were found for any of the variables.
Patient death was reported to lead to both physical and emotional symptoms in academic EPs. Postdeath debriefing appears to happen infrequently in teaching settings, and most respondents reported that they themselves received limited training in coping with patient death. Further study is needed to both identify coping mechanisms that are feasible and effective in emergency department settings and develop teaching strategies to incorporate this information into EM residency training.
人们越来越意识到患者死亡对医生健康的影响，以及进行文化和教育变革以改善应对机制的重要性。本研究的目的是探讨患者死亡对住院医师的影响，以及他们用来应对这些事件的应对机制。
在一个由四个急诊医学（EM）住院医师培训计划的便利样本中，对教员进行了一项关于他们对患者死亡的反应的 15 个问题的在线调查。对数据进行了描述性分析。分析了独立变量，以了解在患者死亡后，他们对身体症状的投诉或对重要生活变化的考虑的差异。
在接受调查的 207 名急诊医师中，有 145 名（70％）做出了回应。他们经常经历患者死亡，其中 95 名（66％）每月至少目睹一次死亡。有 35 名（24％）未接受过应对患者死亡的培训；93 名（64％）的培训时间不足 6 小时。最常见的应对机制包括与同事（113；78％）或朋友和家人（100；69％）交谈，以及简单地继续工作（89；61％）。对于 93 名（64％）的受访者来说，很少或从未进行过死亡后讨论。大多数住院医师对患者死亡有身体反应，最常见的是失眠（54；37％）和疲劳（21；14％）。常见的情绪反应包括悲伤（112；70％）和失望（55；38％）。对于任何变量，在身体症状或生活变化的考虑方面，对物理症状或生活变化的反应率没有显着差异。
患者死亡被报道会导致学术急诊医师出现身体和情绪症状。在教学环境中，死亡后讨论似乎很少发生，而且大多数受访者表示自己接受的应对患者死亡的培训有限。需要进一步研究，以确定在急诊环境中可行且有效的应对机制，并制定将这些信息纳入急诊医学住院医师培训的教学策略。
