|Dealing with Death & Dying
in Medical Education and Practice
© 2001 Kirsti A. Dyer, MD, MS Email:firstname.lastname@example.org
AMSA Convention March 30, 2001
What the Resident Needs to Know
Death pronouncement is more than the actual declaration of death. Residents usually learn about death pronouncement by watching a senior resident perform this responsibility. However, residents have traditionally had little training in examining patients to determine death, notifying families, and in recording proper documentation.
The Phone Call – "Please come and pronounce this patient"
1. Find out the circumstances of the death – expected or sudden?When you get to the floor – Preparation Before You Enter the Room
1. Get the details on the circumstances of death from the RN.In the Room
2. Introduce yourself (including your relationship to the patient) to the family if they are present.
3. Empathetic statements are appropriate:
b. This must be very difficult for you…"
b. "I would also be upset …"
6. Ask if they have any questions. If you cannot answer questions, call someone who can, e.g., the attending.
7. Assess the emotional state of the family; Ask if you can contact anyone for them, e.g. other family, clergy; ask if there is anything else you can do.
1. Identify the patient by the hospital ID tagDocumentation in the Medical Record
1. Called to pronounce (name).The Coroner’s / Medical Examiner Case—
What is a reportable death?
(Note: state/county rules about reportable deaths may vary)
1. If the patient was in the hospital < 24 hoursNotification by Telephone
2. Notify relatives. Next of kin should be notified as soon as possible after you have pronounced the patient dead and notified the attending physician. The family will want to hear this news from someone that they know.
3. If neither you nor the attending know the patient, spend a few minutes familiarizing yourself with the patient’s medical history and circumstances of death. This news is always best delivered in person, but when necessary, you may need to give telephone news:
b. Ask the person you are speaking to identify themselves, and their relationship to the patient
c. Ask to speak to the next of kin
d. Deliver the message: "Mrs. Smith, I am sorry to inform you that your husband died at 8:30 this evening." Avoid euphemisms for death (e.g., passed on, expired).
e. Offer words of comfort (see examples)
f. Ask if they would like to come to the hospital to see the patient. Inform the nurse in charge of this decision
g. Refer questions pertaining to funeral arrangements or personal belongings to administrative personnel on the floor
1. All hospital deaths must be reported to the hospital’s organ procurement organization (OPO) (Federal Law).Resources
1. Amiel GE, L Ungar, M Alperin. Using an OSCE to assess primary care physicians’ competence in breaking bad news. Acad Med 2000;75(5):560-561.
2. Buckman R. How to break bad news: A guide for health care professionals. Johns Hopkins University Press, 1992.
3. Iverson, VK. Grave words: Notifying survivors about sudden, unexpected deaths. Galen Press, Inc., Tuscon, Arizona, 1999.
4. Iverson, VK. Pocket protocols—Notifying survivors about sudden, unexpected deaths. Galen Press, Inc., Tuscon, Arizona, 1999.
5. Marshall SA, Ruedy J. On Call: Principles and protocols. Philadephia, W.B. Saunders Company, 1999.
6. Marchand LR, Kushner KP. Death Pronouncement: survival tips for residents. American Family Physician, July 1998. http://www.aafp.org/afp/980700ap/rsvoice.html
7. Magrane BP, Gilliland MGF, King D, Certification of Death by Family Physicians. American Family Physician, October 1997, 1433-8.
8. Sutton RB. Supporting the bereaved relative: reflections on the actor’s experience. Medical Education 1998, 32, 622-9.
© November 2000 Charlotte Heidenreich, MD David E. Weissman, MD. Death Pronouncement and Death Notification: What the Resident Needs to Know. Available from: EPERC (End-of-Life Physician Education Resource Center) www.eperc.mcw.edu.
Journey of Hearts, www.journeyofhearts.org
This article may be reproduced for educational purposes provided the Heidenriech and Weissman copyright is included.