To the Editor— “Anticipatory grief” is grief that occurs with the diagnosis and/or insight of what is about to come. It is shared between the clinicians, the patient, and the patient’s family. Anticipatory grief is powerful because it acknowledges the seriousness of the situation and its poor prognosis.1–3 We grieve in anticipation of the likely outcome, or what might come to be.
I often hold debriefs with young doctors and clinicians. In a recent debrief, an expression came up that resonated with me: “In times of uncertainty, hold on to your relationships.” This made sense to me as we continue to dissect what we do and all of the metrics we have created around the clinical encounter. It also made sense in light of the prognosis for various types of research and their funding. While there are many relationships to hold on to, it occurred to me that for many of us, an original building block or aspiration remains: the “relationship with the patient.” In other words, going back to the original motivation for a career in medicine, this relationship remains a central motivation in uncertain times. When threatened with anticipatory grief, there is solace in reconnecting with one of the original bricks of our professional foundation.
For such a fundamental concept, it is so hard to explain to someone else—for example, a well-intentioned MBA business manager assessing one’s clinical effort or a friend not in medicine. When we strip away all the outside noise, this relationship with the patient and what it can be is what we can hold on to personally, in addition to relationships with friends and family.
The “magic in the room” is when this relationship goes to the next level in terms of connection and trust—when the clinician and the patient have shared something together—not just exchanged information. This “magic” is rare enough that it creates a “feeling” when it happens. It is that feeling of satisfaction—the feeling that you just connected with why you are a doctor, and that this particular relationship is immune to change or outside threat—because it is a constant and not a function of the times.
In times of “professional anticipatory grief,” hold on to your relationships—particularly the relationship with the patient.
Acknowledgments
The author reports no funding or conflicts of interest.