There was recently a post on kevinmd.com about physician suicide which included a video.

Found here

It’s somewhat of an exaggeration about the constant stressors a physician (a hospitalist in this case) has to face in his/her daily life… however, not by much.

If you google search “Physician Suicide” the top 3 results are:

A Medscape Article – Updated: Jul 09, 2015

A Daily Beast Article – Posted 03.22.15 11:25 PM ET

A New York Times Article – Posted SEPT. 4, 2014

I don’t think we have a great statistic, but the most commonly used one is that: 400 physicians die every year from suicide. This information comes from Pamela Wible, a family medicine physician in Eugene, Oregon who writes about physician suicide. I think we should look at it like this: AT LEAST 400 physicians die every year from suicide. The real number is likely higher than that.

These articles all bring up very common themes about physician suicide, such as how common depression is amongst physicians, the “machismo” culture of medicine, and the fact that physicians are simply more successful in their suicide attempts. Other will point at the stressors of being in medicine, the long hours, the high levels of responsibility, and the list goes on.

However, I think we need to look deeper. I think all physicians have stress in their lives. Somre more than others, of course. But what is it that pushes these physicians over the edge? Depression is common in the medical profession, and is likely undertreated. Other mood disorders like anxiety disorders or bipolar disorder are also likely common. Alcohol abuse and recreational drug use are also likely common.

So what is the real question here?

What makes one physician contemplate suicide, attempt it, and succeed?

The path to becoming a physician is different for everyone, which diverges in medical school, residency and fellowship. Just because someone has similar credentials and the same board certification as you does not mean their path was the same as yours. The level of stress you are capable of handling and that of your colleagues are likely vastly different. And yet, when it comes to medical field, we are all expected to function the same under the same amount of stress. Even worse than that, if you for some reason you “can’t handle it”, you are almost certainly considered “weak” by your colleagues. This “culture of silence” weighs down physicians day in and day out.

Furthermore, there is a stigma against physicians for having a psychiatric diagnosis. Potential employers may consider you “weaker” than your colleagues. Additionally, physicians are continually scrutinized by licensing boards and endless credentialing committees for any kind of negative comment. Of course, any psychiatric diagnosis or prior history of alcohol or drug problems makes it significantly more difficult, usually requiring an essay and/or additional inquiry and/or increased supervision and/or probation.

Is all of this necessary?

Yes, it is. As a physician, you are simply upheld to a higher standard than the rest of the general population, and rightly so since you are taking care of the well-being of others. However, this also prevents physicians “at risk” from seeking the help they need. I can only imagine that when someone hears about a physician suicide that they would respond with “I had no idea.”

That’s the point and this needs to be fixed.

Medical students and residents also likely have a high rate of depression, between 15-30%. I would imagine it is on the high end of that range, so let’s just say 25%. So that means approximately 1 out of every 4 trainees is depressed and needs help. After having gone through my training, that number seems about right. Another study suggests that up to almost 10% of 4th year medical students and interns reported suicidal thoughts in the last 2 weeks. I remember during my intern year that there were a number of lows during that year where it was very difficult for me to get up in the morning, and even a “golden weekend” where I hardly left my bed other than to use the bathroom. I can’t remember if I had any suicidal thoughts during that year, but it wouldn’t surprise me.

So what do we have?

You have a high risk population, with a high success rate, who are unable to get access to the help they need for fear of retaliation. Sounds like a recipe for disaster to me.

I would venture to say that there is one more point that needs to be considered which is somewhat specific to medicine. As physicians, the medical field is our livelihood. Essentially all of our lives have been focused on becoming and being physicians. Losing the ability to be a physician leads to the depths of despair.

“No way out.” “No way to fix my life now.” “I can’t do anything else.” “I’m done for.” “I’m finished”.

These are the thoughts that drive people to suicide, and of course physicians are included. So, if for some reason a physician loses their ability to be a physician anymore — such as losing their job, inability to obtain or complete a residency, losing their license, inability to obtain malpractice insurance— without any hope of being able fix the problem, then I think this group of physicians is at the highest risk for suicide. I would also guess that these are seldomly reported and are usually not heard about. We dedicate so much of our lives to being physicians, that it is nearly impossible for us to see ourselves doing anything else.

Unfortunately, I don’t have a solution to the problem. Furthermore, I think it will get worse before it gets better. However, the take home message from this article is that physician suicide should not be swept under the carpet only to re-appear as an article once a year. It should be actively talked about and researched. We need to find physicians who contemplated suicide and were able to get the help they need. These cases need to be studied thoroughly so we can find out how to intervene earlier. We need to try to bend this “machismo” culture of medicine to be more accepting.

Above all else, we need to candidly talk with our colleagues about suicide and both encourage them and support them to get the help they need. If we don’t, we will continue to lose more physicians every year.

TL;DR

Physician suicide is a problem that no one talks about… but we should.

Physicians are a high risk population, with a high success rate, who are unable to get access to the help they need for fear of retaliation.

Deafeningly silence will lead to more physician suicides. Please talk to your colleagues and both encourage them and support them to get the help they need.

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

You don’t need to fill out your email address, just write your name or nickname.