Grief is not a term that many medical professionals would typically use to characterize their everyday responsibilities. Stress? Certainly. Burnout? Unfortunately, far too prevalent. Exhaustion? Without a doubt. But grief? That feels excessively delicate, painfully vulnerable, intensely personal, too frightening.
However, grief subtly permeates the practice of medicine and the reality of being a physician.
Grief manifests most clearly in the death of patients. Sometimes death occurs unexpectedly, and at other times it follows a long, drawn-out decline. It remains in the memories of cases where everything was executed “by the book” yet nonetheless resulted in a devastating outcome. It emerges when a doctor sits in their vehicle in the hospital parking lot post-code, replaying each moment and contemplating what, if anything, could have changed.
Yet, grief in medicine extends beyond death. Doctors also carry sorrow for the life they envisioned but could not experience. This encompasses lost family time, ideals battered by bureaucracy, career aspirations reshaped by the relentless pressures of the system, and much more.
The various dimensions of physician grief
For numerous doctors, grief accumulates over time. It quietly builds in the background, seldom acknowledged and frequently never processed. Below are some instances I have observed among friends, family, and patients during my therapy sessions with doctors:
Loss of patients. Be it a child in the PICU, a patient you’ve known for many years, or someone whose death you experienced during your first rotation, those memories linger permanently.
Diminished ideals. Many physicians entered the field with a clear sense of purpose: to heal, serve, and make an impact. Years spent dealing with RVUs, EMRs, and battles with insurance can leave one grieving the disparity between the potential of medicine and its current reality.
Personal sacrifices. The birthdays missed, the family vacations interrupted, the guilt of being physically present but emotionally absent. These too represent forms of grief.
Medical mistakes and near misses. Even when outcomes appear “OK,” the burden of an error (or the anxiety of what might have occurred) can torment a physician for years.
Transitions and conclusions. Leaving a cherished practice, shifting specialties, or stepping back from clinical involvement can provoke grief, even when such choices are deemed the “right thing to do.” One forfeits identity, a rhythm, a community.
Systemic inequity. Witnessing disparities in care, or observing patients harmed by insufficient resources or access, incites grief for the injustices a single physician cannot rectify.
Moral injury. Being compelled to discharge a patient sooner than feels appropriate, having insurance deny a medication or treatment you know is optimal, or understanding what care should be provided but being unable to do so. All these scenarios leave behind feelings of grief, guilt, and burnout.
Career detours. The subspecialty you dreamed of but couldn’t pursue, the academic path abandoned due to financial constraints, the leadership role that came at the expense of your clinical identity or work-life balance, along with the opposite of work-life balance and loss of identity stemming from a sought-after leadership or academic position.
Loss of colleagues. Receiving the news of another physician’s suicide or witnessing peers exit the profession entirely introduces its own form of grief, combining sadness with fear, anger, resentment, and more.
The toll on the body. Injuries from prolonged standing, chronic back pain from procedures, or stress-related illnesses can lead to grieving your physical limitations.
This grief is seldom recognized and even more rarely embraced within a community. Instead, it is frequently concealed with humor, stoicism, or by taking on additional shifts.
The importance of acknowledging grief
Unrecognized grief does not evaporate. It manifests in various ways through experiences like irritability, compassion fatigue, numbness, or burnout. Some physicians may find themselves emotionally retreating from patients and loved ones, not out of indifference, but because caring has grown too burdensome.
Recognizing grief permits it to be experienced, and experiencing it allows it to flow, transform, and develop over time. This journey is not about succumbing to the weight of sorrow, but about creating space for the very human reality that medicine is laden with loss, and that loss requires attention over time.
In my practice working with physicians, I frequently hear sentiments like: “I can’t afford to grieve or even feel. If I allowed myself to feel it all, I would never cease crying.”
I have great compassion for this instinctive, human tendency to suppress painful emotions. However, the truth is that grief does not have to be all-encompassing. It demands acknowledgment and a certain level of emotional processing. Therapy can serve as a venue for this. To process the patient you continue to think about years later, the frustration with a flawed system, the sadness of missing significant milestones in your child’s life.
These discussions do not diminish your strength as a physician. They