Decorations, festive scrubs and a cheerful front desk are meant as kindness. For a patient who has lost someone, they can have the opposite effect. Here is what to watch for, what to say and when to refer.
Every December, medical offices do what the rest of the community does. Wreaths go up in the waiting room. Staff wear Santa hats and holiday scrubs. A tray of cookies appears at the front desk. It is meant as kindness, and for most patients it lands that way.
For a grieving patient, it can land as a blow.
Why cheer can hurt
Holidays are built around who is present. Grief is the constant awareness of who is not. Put the two together and the result is predictable: the louder the cheer, the sharper the absence. A patient who has been functioning reasonably well since a death in the spring can walk into a decorated office and feel the floor drop out.
This is not fragility, and it is not depression. It is a normal grief response to a reminder. Grief counselors see it every year, and it has a name: the anniversary reaction. Holidays, birthdays, the date of the death and the date of the diagnosis all do the same thing. The reminder does not have to be a date. A song in the lobby, a familiar perfume or the smell of pine can set it off.
A medical office is a particular kind of trigger. The patient may associate the practice with the illness that preceded the loss. They may be sitting in the same chair they sat in with their spouse. They may be there because they themselves are not well, and the person who used to come with them is gone. The decorations say everyone else is celebrating. The exam room says they are alone.
What it looks like in the exam room
Grief in a 15-minute visit rarely announces itself. More often it shows up as:
- Tearfulness out of proportion to the reason for the visit
- Flat affect, or a patient who is unusually quiet or irritable
- "I’m fine," said in a way that means the opposite
- New or worsening sleep complaints, fatigue, appetite change, vague pain
- A request for something to help them sleep or "get through the holidays"
- Missed or cancelled appointments in November and December
Any of these can have another cause. But if the chart shows a death in the past year or two, or the patient mentions one, the season is the likeliest explanation.
What to do
No extra time is needed, and no one has to be a grief counselor. Three things, in order:
- Notice it and name it. "The holidays can be hard after losing someone. How is this season going for you?" That one question gives the patient permission to say what they were not going to say.
- Normalize it. "What you’re describing is a normal part of grief. It doesn’t mean something is wrong with you, and it doesn’t mean you’re going backward." Many patients privately believe they should be over it by now and that their reaction is a failure. Hearing a physician say otherwise is a relief they will remember.
- Resist the urge to fix it. Sixty seconds of listening does more than any reassurance. A prescription should not be the first response to sadness that has a clear cause. Sleep aids and antidepressants have their place, but grief is not a disorder to be medicated away, and treating it as one tells the patient their feelings are the problem.
Then, if it is warranted, refer.
When to refer
Most grief eases with time and support. A referral is appropriate when a patient shows:
- Grief that is unchanged or intensifying a year or more after the death, with persistent longing, disbelief or inability to re-engage with life
- Functional decline: not eating, not leaving the house, not managing medications
- Any expression of wanting to die or to join the person who died
- A request for help
The Elizabeth Hospice’s Center for Compassionate Care provides grief counseling and support groups for adults and children to anyone in San Diego County and Southwest Riverside County, at little or no cost. The person does not need to have been a hospice patient or family member. Call 833.349.2054 or visit Support.
It isn’t only December
Everything above applies to Valentine’s Day, Mother’s Day and Father’s Day, the Fourth of July, the first birthday after a death, the anniversary of the death and the anniversary of the diagnosis. Patients are often blindsided by their own reactions to these dates because no one warned them. If a patient is known to have had a loss, one sentence at a routine visit can prepare them: "Anniversaries and holidays can bring grief back for a while. If that happens, it’s normal, and you can call us."
About the decorations
None of this is an argument against holiday cheer in a medical office. Most patients like it, and a sterile waiting room helps no one. The point is awareness. Front desk and clinical staff should know that some patients will meet the season with sadness rather than cheer, that it is normal, and that the right response is a kind word rather than a cheerful correction. "Smile, it’s Christmas!" is the wrong thing to say to a widow. If the office has a quieter corner, staff should know where it is.
The most useful thing a physician can do for a grieving patient in December is the same thing that works the rest of the year: see them, say what you see, and tell them it is normal.
Grief support for your patients
The Elizabeth Hospice has served San Diego County and Southwest Riverside County since 1978. Our Center for Compassionate Care offers grief counseling, support groups and children’s bereavement programs to anyone in the community, regardless of whether they had a connection to hospice. Physicians can refer a patient for grief support at 833.349.2054, or learn about hospice and palliative care referrals at 800.797.2050.