General practitioners' beliefs and attitudes about how to respond to death and bereavement: qualitative study   Commentary: Use of personal experience should be legitimised

Abstract Objectives: To investigate the perceptions of general practitioners when they are notified or hear of a death or bereavement in their practice; to explore doctors9 accounts of their relationships with their patients in the context of bereavement; and to explore the concerns of general practitioners in managing themselves and bereaved patients. Design: Semistructured interviews followed by qualitative content analysis. Setting: London borough of Redbridge Participants: 25 general practitioners Results: Almost all the doctors had felt guilty about issues relating to the death of patients. These feelings were based on their expectations of not making mistakes and diagnostic precision. They described a culture gap existing between hospital and general practice and a need to develop new models and methods to explain and manage the causes of illness presented to them. In the absence of useful teaching on bereavement, many devised strategies which relied more on their personal experiences. General practitioners used various methods to contact bereaved patients, especially if they had been involved in the terminal care or if the death was particularly shocking. The doctor was also bereaved by the death of well known patients and sometimes needed to grieve and express emotion. Conclusion: General practitioners may need support and learning methods to manage their own and their patients9 bereavement. Key messages Most general practitioners fear making mistakes because they have a model of diagnostic precision based on their initial professional medical socialisation Doctors differ in their approaches to bereavement management The techniques developed by doctors to manage the immediate phase of bereavement stem from personal experience rather than medical training General practitioners may need to express their own grief at the loss of a patient and a relationship General practice needs to develop its own models to reduce the stress felt by practitioners