Attending a patient’s funeral: how psychiatrists decide

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Psychiatrists often develop long-term relationships with their patients, but what happens when a patient dies? Should the psychiatrist attend the patient’s funeral?

It is an issue that Ashley Pettaway, MD, found as a medical resident in the Department of Psychiatry and Neuroconductive Sciences at the University of Virginia School of Medicine, Charlottesville, Virginia.

For 2 months, Pettaway was involved in the daily care of a woman in her 40s who eventually died. As part of this care, Pettaway had regular meetings with the patient’s husband and relatives.

“The patient was about my mother’s age, so naturally I was a little tied to her,” Pettaway said. Medscape Medical News. After his death, his family invited Pettaway to the funeral.

“Even though I couldn’t get to the funeral, it made me think. Should I go? If I go, what do I say? Who do I sit with? How do I present myself?” Pettaway wondered.

He turned to literature, but found very little about psychiatrists attending the funerals of his patients. “This surprised me because, in psychiatry, you can feel so engrossed in patients’ lives, ”Pettaway said.

Faced with a lack of formal rules or guidelines about psychiatrists attending patient funerals, Pettaway and a colleague, Gabrielle Marzani-Nissen, MD, conducted an informal survey of 12 supervising psychiatrists at the University of Virginia.

The results of the survey were presented at the 2021 annual meeting of the American Psychiatric Association (APA) virtual.

Ten of the 12 psychiatrists surveyed cared for a patient who died while in his care. Five of these psychiatrists reported going to the funeral of at least one patient throughout their career.

Among psychiatrists who attended a patient’s funeral, their care was often based on their clinical intuition, their relationship with the family, or whether the patient had an established presence in the community. In the latter case, the psychiatrist attended as a member of the community.

The number of years in practice also mattered. Less senior teachers reported that they would be reluctant to attend and would not attend without a formal family invitation. Senior career psychiatrists were more likely to attend and felt that an invitation was not needed.

None of the psychiatrists surveyed had received training or guidance to attend patients ’funerals at any point in their careers.

Given the absence of formal recommendations, Pettaway believes that greater conversation on this topic, as part of residency training programs, would help psychiatrists navigate these complex situations.

A complex issue

Commenting on the topic for Medscape Medical News, Paul S. Appelbaum, MD, a professor of psychiatry, medicine and law at Columbia University in New York City, said this is an “interesting and important topic that is not debated.”

“I don’t think there is a right answer that applies to all situations,” said Appelbaum, former president of the APA.

There will be times, he said, when psychiatrists or other mental health professionals have worked closely with a patient for many years and may have interacted with the family during that period.

“When this patient dies, he can feel and the family can feel that it would be comforting and appropriate for them to be at the funeral,” Appelbaum said.

However, he added, it is important that psychiatrists “take the initiative of the family.”

“Clearly there are a number of complexities involved. One is the way the family feels about the relationship with the psychiatrist, whether it was accepting the reality that the patient had a mental disorder and was in treatment,” he said. .

There is also the issue of confidentiality, Appelbaum said.

“If it’s a big funeral and the psychiatrist is just a face of the crowd, it’s probably not going to be a problem. But if it’s a relatively small group of bad guys, who all know each other and an unknown figure appears, you could to ask questions and perhaps inadvertently reveal to relatives or friends that the deceased had a psychiatric condition and was in treatment. This should also be taken into account, “he added.

In cases where the family invites the psychiatrist, confidentiality is not a concern and the psychiatrist’s assistance is something the patient would have wanted, Appelbaum said.

The way the patient died can also be an important factor. When a patient dies suicide, is an “emotionally charged situation for both parties,” Appelbaum said.

In the case of a suicide, he noted, the deceased was often an active patient, and both the psychiatrist and the family face strong emotions: the psychiatrist laments the loss of the patient and perhaps with questions about what could have been done. differently, and the family in grief, but “also sometimes with suspicion or anger because the psychiatrist somehow was unable to keep the patient alive,” Appelbaum noted.

“In this situation, it is even more crucial for the psychiatrist or other mental health professionals to take the lead in the family, perhaps to initiate contact to express condolences and gently ask about funeral arrangements and whether their presence would be welcome. “, he said. .

The research had no specific funding. Pettaway and Appelbaum have not disclosed any relevant financial relationship.

Annual Meeting of the American Psychiatric Association (APA) 2021: Presented May 1, 2021.

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