By Larry Dawalt, M. Div., BCC, CT
Dr. Smith and I agree that grief ‘is as individual as the relationship that brought it about.’ It’s not one size fits all.
Unless they come right out and tell you, how do you know a person is grieving? Are there some relevant signs? What part does grief play in the overall wellness of a person? I’ve been asked some of these questions over my years as a grief counselor, but in order to consider these questions from the perspective of a physician, I sat down for a conversation with Hospice & Palliative Care Charlotte Region Medical Director, Dr. Bob Smith, to get his perspective from his years as a family physician. “If I was a physician and someone came to my office whose spouse had just died but I didn’t know it, and I asked them how they are doing, nine times out of 10 they would say fine,” Dr. Smith said. “So that question may not get a lot of information. But if a person comes in and you ask them how many times in the past week have you missed your medication, and they say a few times, four times, maybe five or six times in the past week, they’re telling you they’re okay, but not showing it. What they may be saying is that I am neglecting my health because I am in the grieving process.” There are other physical indicators as well that Dr Smith says a physician may observe. “I look for changes in a patient’s blood pressure, blood sugar levels and other lab results that may indicate distinct changes, especially if they have been a caregiver. Being a caregiver is very difficult because sometimes a person may have neglected their own health while they are caring for a loved one.” Dr. Smith emphasizes that it may be harder to get details because times have changed when it comes to the physician/patient relationship. “In our modern medical world, when you’re seeing 20-plus patients a day and doing all the documentation and orders that go with that, it’s not as easy to have a relaxed, personal conversation. You may find yourself in a situation where you have to actually take ‘fine’ at face value and go on. And it’s different when you’re not seeing patients in the hospital, or in a place where you know their family members. You don’t always get the information you maybe used to get,” he stated. As a patient who is also a grief counselor, when I visit a physician, I look for screening questions that may indicate the potential for grief and loss. One question I look for is, ‘Have you had any specific life changes in the last year?’ This question, followed by a long blank line or two for elaboration, may give a physician the opportunity to get some news without having to probe. What a physician does with that news can help a patient make the physical adjustments necessary to have the strength to carry on as they grieve. But Dr. Smith reminds us that physicians don’t have to go it alone. “I would suggest that physicians acquaint themselves with the resources available in their community. We are fortunate in this area to have our hospice grief counselors and others who are trained in grief care. But it’s also important to allow a person to help you help them find the right fit. Support groups or even grief counseling may not be part of their family culture or of their psychic make up. That may not be who they are. I think grief is very normal and natural and I think we need to embrace that and not try to rush the process, or make it something pathological. We can walk with them and offer them some insights that we’ve discovered as we’ve helped others.” Lastly, Dr. Smith and I agree that grief ‘is as individual as the relationship that brought it about.’ It’s not one size fits all. Also, during these pandemic days, traditional social support is not as readily available; which means more people may be struggling. This makes caring, compassionate care from a physician even more valuable- and appreciated.