Losing Patients Watch

Kikiyo
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#1
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Hi all,

I was simply wondering when you lost your first patient and what was it like. I am very much excited at the prospects of studying medicine and treating people however the idea of loosing a patient scares me quite a bit. I would be quite upset, especially if I knew it was my fault (perhaps I didn't react quick enough or misdiagnosed). I do not know how early you would start treating people (I presume it is different for each university) but i am just scarred of such a thing happening. Or would I always be supervised and such for the whole 6 years of the course before I would be in a situation for such a thing to happen?
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j00ni
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I lose patients all the time, not that upsetting as i tend to find them again weeks later outlied on a surgical ward
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Becca-Sarah
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I lost one of my psych patients when I took them outside for a fag. That was definitely a brown pants moment.

OP, you're gonna be qualified before it's actually your fault that someone died.
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Helenia
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You will probably see patients die as a medical student, but it would never be your "fault" as you don't have any direct responsibility for your care and it would be pretty near impossible for you to kill them without some malicious intent. Once you start to be a junior doctor once again you will see people die, but only in a handful of cases will it ever be somebody's "fault" and even then it shouldn't be yours as if you are a good junior you should be calling your seniors once you recognise things are going tits up. Most of the time people die because their disease beats our treatment rather than necessarily because somebody did something wrong or you "could have done more."

It is sad when patients die, especially if they've been with you for a while and you've got to know them and their family. But my philosophy is that everyone has to die sometimes, and although we can try to prevent it, there comes a time when the right thing to do is for us to hold our hands up and realise it's time to withdraw. This doesn't, of course, necessarily apply when it's a sudden or unexpected death, which requires a different mindset to handle, but even so, in most circumstances blaming yourself will not help. Some deaths stay with you longer than others (paediatric/perinatal ones particularly for me) so you have to acknowledge when something has upset you, discuss it with the rest of your team, and move on, allowing yourself to feel sad but not letting it take over.
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junior.doctor
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As a student, you would be heavily supervised - whilst you will be involved in making decisions with the team, you will never be in a position where you have to make treatment decisions on your own as a student. You will also not be alloed to prescribe anything - many students practice by writing up drugs etc on drug charts, but a doctor has to sign them (and thus check them, and take responsibility for them). Many clinical teams will allocate you your own "patients" - but this basically means taking a particular interest in these patients, following them closely, accompanying them to theatre or to endoscopy if they need a procedure, reading up on the background / potential differential diagnoses, and what the treatment options might be. You would then probably be expected to present these patients at the ward round. If yoou're on call and clerking patients, you do the history and examination, probably the bloods and the cannula, make an impression as to what you think the problem is, and a differential diagnosis, but then you present to a doctor who makes the final decisioon and treatment plan - so again you are not responsible for final decisions. You will still find that some of these patients will die though. In some ways, it depends how stuck in you get with clinical medicine, but it's likely at some point in thrid year, particularly if you follow the on-call team and attend crash calls with them. I had worked in a nursing home before I went to med shcool (as a weekend job) and so I'd seen a couple of people die then, so that wasn't so new to me. usually, junior docs are aware that 3rd years might be experiencing the death of someone for the first time, but if not then talk to them about it when you get to that point - when doctors have more difficult deaths (like in paediatrics) it's important to "debrief" to each other. but don't worry, as a medical student you won't be making big decisions - someone will always talk them through with you and make the final decision.
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_Spoon
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When you first lose a patient you will generally experience the 5 stages of bereavement (denial, anger, bargaining, depression, acceptance). However, you tend to become less emotionally attached to the patients as your training goes along. I used to work as an HCA before coming to medical school and I had experienced losing patients almost all the time as I worked on a geriatric ward. This did help me to be more psychologically prepared to face patient death as a medic.

At the end of the day, as long as you did your best, you should never feel guilty for the loss or discouraged for your career. Because you were the one that looked after them and make them comfortable at the end of their life journeys. And in fact, you will find that's one of the greatest satisfaction you can get as a health profession.
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Spencer Wells
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(Original post by _Spoon)
When you first lose a patient you will generally experience the 5 stages of bereavement (denial, anger, bargaining, depression, acceptance).
I'm pretty damn sure that I've never been in denial about a patient death, or bargained about it. The 5 stages tend to apply to either patients given a terminal diagnosis, or their relatives/friends upon hearing the news.
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thisismycatch22
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(Original post by Spencer Wells)
The 5 stages tend to apply to either patients given a terminal diagnosis, or their relatives/friends upon hearing the news.
If that...
http://www.psychologytoday.com/blog/...o-stages-grief
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