| Lack of academic preparation in addressing issues related to the impossibility of cure and death |
In college, nobody prepares you to deal with death; in college, they teach you everything you need to do to keep the patient alive until the day your patient dies. Then you have to deal with the first frustration of your life, and, over time, depending on where the doctor works, death becomes part of the routine (I11, General Surgery, M, 39 years old).
We see [the approach to] death during our undergraduate studies as a great villain (I3, Anesthesiology, F, 42 years old).
We were trained to be the superhero, the savior, the conqueror of death. They never tell you: you are going to lose. You are going to lose many times. They don't teach you that; you learn it the hard way. I missed this preparation for delivering news to families in case of death or disease without prognosis. None of this is explored in academia (I23, Internal Medicine, F, 57 years old).
We are trained to prolong life but to deal with death... you notice with the residents that they don't like to stay here [unit for chronically ill patients] because they think: wow, what a boring thing... everyone is dying. So, no one wants to stay in this place, close to death (I32, Internal Medicine, F, 56 years old).
I never had the opportunity to observe or simulate delivering death news in college (I19, Neurosurgery, M, 32 years old).
I notice that doctors in training are prepared to diagnose and treat. Many times, patients are incurable, so we treat symptoms, provide palliative care, improve quality of life, etc. But, for many doctors, the patient's death is a failure, and sometimes it is not a failure; it is an expected outcome (I14, General Surgery, M, 47 years old).
There is no such preparation from an academic standpoint. Schools do not prepare the student, the future doctor, for this [death, impossibility of cure]; it is a matter of day-to-day practice, your residency, your work later as a doctor, as a surgeon; it is something you learn through suffering (I10, General Surgery, M, 39 years old). |
| Lack of academic preparation - interpersonal relationship (beyond the patient) |
There was nothing that addressed the relationship of the doctor with other people. I graduated without understanding that I would be working with people, not just the patient, but also a range of other people I would also be responsible for. Because when I am with a patient, they have siblings, uncles, parents, grandparents, neighbors, friends, and teachers. So, we are not only responsible for the patient; we have to take a few minutes from the shift for these other 'patients' who come along (I37, Pediatrician, F, 58 years old).
School teaches us a lot about disease. Life teaches us about the patient. These are two different things: disease and the patient. I have always believed that it is fundamental in medical training to have a foundation to better understand the human being, including the relationship with the family and the patient (I8, General Surgery, F, 58 years old).
We have nothing in college regarding contact with the family. No subject prepared you for this. It is much more about science than the human aspect. The human part, the human relationship, is very deficient. I missed that a lot and had to learn it in practice (I28, Intensive Care, F, 49 years old). |
| Lack of academic preparation related to contact with professional practice (communication of bad news, among others) |
We graduate without adequate practice; you feel totally incomplete (I25, Internal Medicine, F, 56 years old).
No college class teaches to deliver news; I learned that in practice by accompanying those with experience. So, the student who spends time here in the hospital, for example, we notice that they are interested when we deliver news to someone about death; they want to see how it is, how it is done, how it should be done. Because, in fact, they do not graduate prepared for this, including being prepared to face death. In college, we learn to save lives. Everything we learn there is aimed at keeping the patient alive. Once outside [the college], we try to apply everything we learned there, and we realize that sometimes, no matter how much effort we put in, the patient ends up dying, and many are not prepared for that. Some students and doctors at the beginning of their careers are genuinely very shaken by such situations, to the point that they sometimes cannot cope well with such scenarios (I11, General Surgery, M, 39 years old).
I missed it. We have a little of this approach in the medical psychology subject. And we see that today›s students really miss this. They come to me, eager to know how to deliver the news to a family member. This is very interesting because it shows that we miss this approach in our undergraduate studies (...). There should be a subject to show what death is, what it means to you, how you can deal with it, how you will deal with family members, so I think there would be no shortage of topics in this approach, and we feel the lack of it keenly (I16, Neurosurgery, M, 32 years old).
I think it should be a topic better addressed during medical training. I think anthropology [subject] should play a bigger role. It is a subject usually included at the beginning of the curriculum and does not spark much interest in students because they have not yet gone into practice... However, once we are more experienced, we will see the importance of this subject, which should be at the end of school (I2, General Surgery, M, 41 years old).
The approach to death during undergraduate studies is very limited... You have some subjects [addressing] the doctor-patient relationship, [such as] medical psychology, which covers it a little, but... not necessarily death, so you don›t see that in college. When it does occur, it is at the beginning of the school, and at the beginning, you don›t understand anything... oh, we read that book ‹Sobre a Morte e o Morrer (On Death and Dying)...› you read it and all, but you haven›t yet gone into practice; you don›t know the things they talk about there (I9, General Surgery, F, 38 years old).
Only after you leave the school do you realize something was missing in terms of contact with practice (...) Whether you like it or not, it›s a reality check because medical students here have a slightly higher socioeconomic level than the patients, and most students here have not had contact with these stories, like the extreme poverty of the patients, lack of education (...) In college, we are trained to pretend when we see all these things. There is societal pressure that medicine is the ‹best profession,› as if we were a resilient wall to handle everything. I saw many cases in college of colleagues who were depressed; there are stories of attempts and actual suicides, drug use (...). The study itself is not that [difficult], but the psychological part is much heavier. Being admitted into the school is hard, but graduating is much harder (I34, Internal Medicine, F, 29 years old). |
The communication of bad news in the emergency hospital
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Source: Authors.