You can't save every patient

I remember the first time I realized I couldn’t help a patient—and the feeling of helplessness that came with it.

During an ER shift early in my career, an elderly woman who’d lost consciousness came in by emergency medical services. A CT scan of the head determined she had an acute brain bleed. After consulting with neurosurgery, there was nothing we could do besides make her comfortable.

She was accompanied by her husband of 45 years and adult children. I felt powerless because although she was still alive, we knew there was no chance for recovery. I tried to console the family as best as I could, but not being able to save this patient was heartbreaking. She passed peacefully in the ER within hours. 

I believed my role was to save lives and cure diseases. When I couldn’t do that, I felt helpless—and sometimes hopeless.

Then I read this 19th century quote from Dr. Edward L. Trudeau that gave me a new perspective on how we can serve patients in different ways: Our job as a physician is "to cure sometimes, to relieve often, to comfort always."

Those seemed like reasonable words to live by. After all, if incurable and progressive diseases always led to feelings of helplessness among healthcare providers, we would be in a constant state of mental and emotional paralysis. 

Learned helplessness and how to overcome it

In psychology, there's a mental state called "learned helplessness" that occurs when someone continuously faces a negative, uncontrollable situation and stops trying to change their circumstances—even when they can.^[]

For example, some healthcare providers may continually try to cure their terminal cancer patients but after losing several, they may grow frustrated, come to believe nothing they do will help, and feel like giving up.

One way to counteract these feelings is to focus on the good you do. Remember the patients you’ve saved, diseases you’ve cured, families you’ve comforted, and those you advocated for throughout their terminal illnesses.

It also helps to identify situations in which you feel helpless as a provider. The feeling of helplessness often comes:

• When we cannot save a dying patient

• When we struggle to help a non-compliant patient

It's understandable that these feelings surface when we encounter death, especially with young patients who suffered a tragic accident or who have an unknown, underlying etiology. We may not be able to save them, but we can provide comfort and relief.

But what happens when patients do not want to get better or help themselves? 

Put the power in your patient's hands

I see so many patients who don’t want to take their insulin or talk about their increasing blood pressure and cholesterol. It’s very frustrating because I want to help them, and know that keeping compliant with medication and lifestyle changes can improve their conditions.

Although I feel helpless in such cases, I’ve learned to put the power in their hands. Making it their decision based on their desire to get better (or not) encourages them take ownership of their treatment.

You can help them feel they are in the driver's seat by framing questions like this:

• Why are you here today?

• How do you want me to help you?

• What would you like me to do for you?

• What would you like to happen now?

Work through your feelings as a provider

Helplessness can leave you feeling defeated and hopeless. If you feel you’re continuously failing your patients, ask yourself some tough questions and consider seeking professional help:

• Have you been coping with a great deal of stress lately?

• Is something happening in your life that’s outside your control?

• Have you struggled with other symptoms such as low mood, sadness, hopelessness, and loss of interest that may point towards depression or another mental health disorder?

• Have you been using food, drugs, or alcohol to help numb these feelings?

If you answer yes to some of these, consider talking to a therapist about your thoughts and emotions. It’s essential to address these underlying feelings before they affect your life, work, and patient care.

These tips can help, too:

• Focus on what you can control. We can control how we communicate with our patients, reassure family members, and advocate for the best treatments.

• Seek out support from others. Surround yourself with friends, family, mentors, and co-workers who can help you work through feelings of helplessness. 

• Remember patients you’ve helped. For every patient you’ve lost, there’s at least one you’ve saved (and many more you’ve helped). It’s easy to focus on the difficult outcomes; remember the positive results and the greater good you’re doing. 

• Accept that it’s not always your role to cure. Even if we try our hardest, sometimes death is inevitable.

• Remember to take care of yourself. If you’re not in a healthy state of mind, you may be putting patients at risk. Take care of yourself first by adopting everyday self-care routines.