The Letter of Condolence

Reprinted and adapted from Ethics Rounds, Fall 2002.

“A physician’s responsibility for the care of a patient does not end when the patient dies. There is one final responsibility—to help the bereaved family members. A letter of condolence can contribute to healing a bereaved family and can help achieve closure in the relationship between the physician and the patient’s family … Whether intentional or not, the failure to communicate with family members conveys a lack of concern about their loss.”¹

It has been said that we are more likely to receive a condolence card from our veterinarian than we are from our personal physician.

In a recent column for Clinician-Patient Communication,² Dr Scott Abramson, Neurology, Hayward, CA, tells the story of a young woman he talked with whose father died the month before, under the care of KP clinicians. She said, “After he died, I heard not one word from Kaiser. Not one phone call; not one condolence card. Doctors and nurses showed such great concern while he was dying; yet after his death, it was as if he never existed! I felt hurt. I felt abandoned.”

In a noteworthy article extolling the value of writing letters of condolence, Bedell, Cadenhead, and Graboys¹ outlined why doctors do not regularly write letters of condolence. Reasons included a lack of time, a feeling that they did not know the patient well enough, no specific team member was responsible for writing the letter, a loss for words, and difficulty with their own experience of the loss as a sense of failure.

Generally, in the larger context of medicine, the focus is on cure—not on what to do if a disease cannot be cured. Slow integration of palliative care, relatively few discussions about advanced care planning, delayed referrals to hospice, and reluctance to follow up with family members when our patient dies are all behaviors that show how difficult it is for those of us in health care to focus on dying and death. That is not to say that the will to do more is not there—culture and lack of training may be the culprits.

In one small way, you can make a difference: to others and to yourself

Bedell et al¹ highlight the benefit of writing a letter of condolence as twofold: to be a source of comfort to the survivors and to help clinicians achieve a sense of closure about the death of their patient. In the sidebar on the previous page, Dr Mark Geliebter, Martinez, CA, describes how he began writing letters of condolence to his patients and the value this practice has had for him.

If you decide that writing a letter of condolence is a practice you would like to begin incorporating into your medical practice, the following guidelines, adapted from Wolfson and Menkin’s “Writing a condolence letter,”³ may be helpful.

• Address the family member. Dear Mrs Wagner, …

• Acknowledge the loss and name the deceased. Dr Murphy and I were deeply saddened today when we learned from your hospice nurse Lois that your mother, Ruth Smith, had died.

• Express your sympathy. We are thinking of you and send our heartfelt condolences.

• Note special qualities of the deceased. It seems like only yesterday that Ruth talked about her love of card playing. I admired her energy and quick wit.

• Note special qualities of the family member. I was deeply moved by the devotion you and your family showed during the period of Ruth’s final illness. Your concern was one indication of your love for her. Although she was a fiercely independent woman, I know she appreciated your involvement and help.

• End with a word or phrase of sympathy. With affection and deep sympathy, we hope that your fond memories of Ruth will give you comfort.

Throughout KP Northern California, some departments, team members, and individual clinicians have chosen to routinely send letters or cards of condolence to family members when a patient dies. Clinicians report the deep satisfaction they feel in this act of follow-up; family members report their heartfelt thanks that KP clinicians took the time to recognize the family’s grief and their role in the care of the patient. Letters of condolence can make all the difference—to our members and to us as clinicians.

Biography

Cecilia Runkle, PhD, is a Training and Development Consultant with The Permanente Medical Group Inc in Physician Education and Development where she specializes in clinician-patient communication. E-mail: cecilia.runkle@kp.org.